Provider Enrollment Manager Steward Medical Group, Brighton, MA
Full-time, day shift
This position will oversee the day to day provider enrollment and credentialing activity in the Provider Enrollment Department. They will provide supervision and direction to the Provider Enrollment personnel to ensure the timely credentialing of physicians and advanced practitioners with third party payers.
Manage the department to:
Ensure the timely submission and follow up of contracts and documentation with the payers to ensure that each provider is billing ready upon the commencement of their employment.
Ensure the timely submission of re-credentialing documentation for each provider.
Responsible for quality and productivity metrics directly related to Provider Enrollment tasks.
Provide clear direction for staff by establishing goals, objectives, policies, procedures, performance improvement programs, and action plans as needed.
Actively and continuously analyzes workflows, organizational structure, staffing assignments or other factors to ensure optimal performance; makes recommendations and modifications, as necessary.
Focus on continuous improvement, changes departmental practices/processes to meet changing needs of the business, and audit department work product to maintain quality of work performed through ongoing department-wide quality improvement monitors.
Oversee maintenance of Provider Enrollment Databases.
Responsible for the timely updating of the Provider and Referring physician dictionaries, interface with CAQH and other s/w applications as appropriate.
Work to identify best practices and implement new processes and polices in order to improve the credentialing process with the payers.
Work collaboratively and build relationships with the third-party payers in order to ensure that billing time lines and revenue opportunities are optimized.
Effectively communicate with management the status of the providers with the third-party payers.
Maintain unit specific turnaround time levels in accordance with departmental Policy Procedure.
Identify discrepancies, develop solutions and initiate action plan for correction when necessary.
Ensure compliance with state and federal regulations, and policies & procedures.
Play a significant role in long-term planning, including an initiative geared toward operational excellence.
Oversee overall planning, systems and controls.
Steward Medical Group (SMG) is a physician led, multispecialty practice organization with more than 1,000 physicians providing high-quality patient care throughout four states. Offering primary care and specialty services, our team of providers work collaboratively to improve patient outcomes through preventative care.
Steward Health Care System is comprised of 18 hospitals in Massachusetts, Florida, Ohio and Pennsylvania and more than 24 affiliated urgent care provider locations. At Steward, we are committed to compassion, accountability, respect and excellence. Headquartered in Boston, MA, Steward Health Care System is a community-based accountable care organization and community hospital network with more than 17,000 employees serving more than one million patients annually in 85 communities.
To apply online, a direct link to the position can be had here:
At Steward, we believe in honesty, integrity and the importance of community care. More importantly, we believe in our people. We offer competitive salaries and benefits. All inquiries will remain confidential. Steward Health Care System is an equal opportunity employer.
REQUIRED KNOWLEDGE & SKILLS:
Firm understanding of the provider payer enrollment process.
Demonstrated leadership and vision in managing staff groups and major projects or initiatives.
Ability to look at situations from several points of view.
Persuasive with details and facts.
Delegate responsibilities effectively.
Excellent interpersonal skills and a collaborative management style.
Ability to work well with all levels of personnel and to communicate effectively, both orally and in writing.
Proven ability to maintain sensitive and confidential information.
Excellent problem solving skills.
Excellent PC based application skills including Excel, Access and Word.
Ability to prioritize effectively in a high-volume environment.
Project Management experience.
Bachelor’s Degree preferred.
Five to seven years of progressive work experience in provider enrollment, physician practice credentialing or practice accounts receivable management in a management position.
MS Office Suite, working knowledge of Cactus/Symplr and/or AthenaHealth practice management system strongly preferred.