Provider Enrollment Manager
Provider Enrollment Manager
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Job Description
Integrative Emergency Services LLC (IES) is looking for a Provider Enrollment Manager.This position leads and oversees all provider enrollment operations and ensures timely accurate and compliant processes across payors states and clients. This position partners closely with Credentialing Revenue Cycle Finance and Clinical teams to minimize held A/R and maximize revenue cycle performance. This position plays a key role in driving process improvements maintaining relationships with key payors and ensuring excellence in service delivery.
IES is dedicated to cultivating best practices in emergency care providing comprehensive acute care services creating value and supporting patients employees clients providers and physicians in pursuit of the highest quality health care.
Applicants must reside in a state IES operates in (AZ CO OK TX IN AL SC FL)
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
- Provide leadership and supervision to the Provider Enrollment team including coaching development workload allocation and performance management.
- Own the full lifecycle of provider and group enrollment with commercial and government payors; ensure accurate and timely submission of applications.
- Serve as the primary escalation point for enrollmentrelated issues rejections or payer delays. Serve as the subject matter expert for group provider enrollment related matters. Oversee new group setups and ensure required documentation is submitted to the billing company.
- Monitor and report on enrollmentrelated SLAs KPIs and A/R held due to enrollment issues; collaborate with the Billing team to mitigate risk.
- Ensure compliance with enrollment regulations and internal policies including CAQH reattestations statespecific rules and payer documentation standards.
- Lead efforts to resolve complex enrollment issues and support the team with payer or clientfacing escalations.
- Maintain strong payer relationships and serve as a liaison to escalate unresolved enrollment bottlenecks.
- Partner with other departments including but not limited to Credentialing Recruiting Revenue Cycle Finance and Clinical Operations to ensure a seamless experience.
- Lead enrollmentrelated project initiatives working closely with crossfunctional partners and creating detailed plans and timelines to track progress.
- Support and refine reporting dashboards and analytics to track enrollment timelines and team productivity.
- Drive continuous improvement of workflows and procedures; collaborate with internal stakeholders to identify opportunities for automation or optimization.
- Maintain and enhance standard operating procedures (SOPs) and documentation for internal and external audits.
- Maintain uptodate knowledge of payer and regulatory requirements and industry best practices; share guidance and lead changes accordingly.
- Foster a culture of accountability operational excellence and continuous improvement.
- Ensure that clinicians and clients receive toptier services throughout the enrollment cycle. Develop performance measurements to effectively maintain service level agreements and key performance indicators while adhering to budget. Create and maintain dashboards for the business and/or clinical or management company leadership.
- Maintain current subject matter knowledge and expertise regarding regulatory changes trends best practices and technologies. Use knowledge to provide advice and guidance surrounding solutions for enrollment.
- Manage to extremely high degree of accuracy with enrollment compliance to avoid timely filing or held A/R issues. Work closely with management leadership and finance to analyze and resolve held A/R issues. Facilitate meetings with billing company regarding enrollment status and current projects.
- Handle sensitive information in accordance with company protocols and ensure data security
QUALIFICATIONS
Knowledge Skills Abilities: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Strong working knowledge of provider enrollment processes and payer regulations (Medicare Medicaid commercial payors).
- Experience leading teams with multiple layers.
- Excellent interpersonal and communication skills including the ability to interface with senior leadership and external partners.
- Strong analytical and problemsolving skills; ability to interpret data and implement performance improvements.
- Proficiency with Microsoft Office Suite (especially Excel) and experience with enrollment systems and tools.
- High attention to detail with the ability to manage competing priorities effectively.
- Knowledge of revenue cycle impact from enrollment delays or rejections.
- Strong customer service orientation and project management capabilities.
- Ability to use discretion appropriately and maintain confidentiality
- Ability to read write and speak English proficiently
Education / Experience: Include minimum education technical training and/or experience preferred to perform the job.
Required:
- High school diploma or GED
- Minimum 4 years provider enrollment experience
- Minimum 2 years prior leadership experience
- Experience working with multistate or multipayer environments
Preferred:
- Bachelors degree
- Previous experience working with CAQH and payer portals
- Familiarity with billing workflows and A/R management
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Specific vision requirements include the ability to see at close range distance vision peripheral vision depth perception and the ability to adjust focus
- While performing the duties of this job the employee is regularly required to talk and hear
- Frequently required to stand walk sit use hands to feel and reach with hands and arms
- Possess the ability to fulfill any office activities normally expected in an office setting to include but not limited to: remaining seated for periods of time to perform computer based work participating in filing activity lifting and carrying office supplies (paper reams mail etc.
- Occasionally lift and/or move up to 2025 pounds
- Fine hand manipulation (keyboarding)
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Office environment
- May visit hospital locations and vendors
- The noise level in the work environment is usually low
- Although work may be performed remotely applicants must reside in a state IES operates in (AZ CO OK TX IN AL SC FL)
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
The company is committed to creating a diverse inclusive and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age race religion nationality sexual orientation gender identity or expression disability or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds experiences and abilities and believe that the unique experiences of our team drive our success.
Required Experience:
Manager
Employment Type
Full-Time
