The Provider Enrollment Manager is responsible for managing all aspects of the enrollment process for all MedOptions Clinicians with Medicare/Medicaid and Commercial payers. The Provider Enrollment Manager will work with the Contracted 3rd Party Vendors as well as directly with payers to establish processes, manage priorities, monitor progress of enrollment applications and document status and process. The Provider Enrollment Manager will work with internal teams to determine priorities and provide dates that enrollments will become active. Working with MACs, Medicaid agencies and commercial payers to address questions and concerns as they arise regarding all aspects of enrollment. Regular reporting is an important part of the Provider Enrollment Manager responsibilities.
· In partnership with enrollment vendor, identify issues that require additional investigation and evaluation, validate discrepancies and ensures appropriate follow up.
· Reports status of all applications and overall enrollment completion to leaders within the organization.
· Interacts with Clinicians and Administrative staff to ensure they understand the enrollment process as relevant to them, responds to their questions and concerns and report on their individual enrollment activities.
· Communicates with Medicare/Medicaid and Commercial payers regarding specific enrolling questions and updates profiles accordingly.
· Manages all payer delegated credentialing audits; conducts internal file audits as needed; conduct annual sub-delegee and other audits of credentialing/enrollment vendor as needed.
· Assists with review and updating of the MedOptions payer manual.
· Collaborates with Director on various projects surrounding payer contracts and delegated agreements.
· Participates in staff meetings and assigned continuing education, and recommends new approaches, policies, and procedures to effect continual improvement in efficiency of the department and services performed.
· Maintains a strict level of confidentiality for all company, departmental, and healthcare provider information.
· Ability to communicate effectively, both orally and in writing.
· Ability to partner effectively with different constituencies and stakeholders.
· Ability to effectively manage multiple deadlines and priorities.
· Knowledge of related accreditation and certification requirements.
· Knowledge of medical credentialing and privileging procedures and standards.
· Ability to analyze, interpret and draw inferences from research findings, and prepare reports
· Informational research skills.
· Ability to use independent judgment to manage and impart confidential information.
· Database management skills including querying, reporting, and document generation.
· Ability to make administrative/procedural decisions and judgments.
· Other tasks and duties may be periodically assigned by your Supervisor.
EDUCATION AND LICENSING:
· Bachelors or Associates degree preferred or High School Diploma/GED and 2+ years of experience in enrollment or provider network compliance.
KNOWLEDGE, SKILLS AND ABILITIES:
· 2+ years’ experience in healthcare administrative setting/personnel administration
· 2+ years’ provider credentialing experience preferred; certification desired
· Professional and effective oral and written communication skills
· Organizational skills; ability to multi-task and manage priorities; meet critical deadlines
· Proficient in Microsoft Excel, Outlook and Word and proprietary database applications. Experience with MS
· Demonstrated ability to work on a computer including but not limited to: using the Internet, Microsoft Outlook, Microsoft Excel and MedOptions’ Electronic Health Record and other
· MedOptions is the largest provider of behavioral health services to skilled nursing, long-term care facilities.
· Our clinical team consists of psychiatrists, nurse practitioners, psychologists and LICSWs.
· We want our clinicians to focus on providing the best quality care so we give you the tools to do that—EMR system, clinical protocols, free online CEUs, and webinars on topics relative to the work we do.
· We do all of the billing and take care of the administrative aspect of care—you see patients and do the documentation.
Do you want to be part of a dynamic company that is the leader in their industry? Then we want to hear from you. MedOptions is the leading provider of behavioral health services to residents of nursing homes and assisted living facilities.
Our growth has created numerous opportunities throughout the states we provide service. We are looking for clinicians who have a passion for the elderly and providing the best quality behavioral health care for those residents. It's important for our clinicians to develop relationships with the residents and facility staff to provide consistent and reliable care.