Supv, Prov Enroll-Life Cycle

Job Summary

• Supervises the operational efficiencies for the entire network of 82000 providers provider groups and facilities to resolve complex provider issue (inquiry) resolution provider reimbursement issues drives large provider group Operational Committee meetings to identify and establish root cause problem resolution.
• Supervises team members to achieve business goals that include maintaining productivity standards and quality standards. Develop implement and maintain performance tracking and trending tools to allow for monitoring of overall team.
• Acts as project leader on the most complex special projects utilizing project management and technical computer skills to ensure all project activities is completed in an accurate timely manner.
• Serves as the subject matter expert on the end-to-end operational administration for systems set-up configuration and issue resolution.
• Supervises the organizational operational efficiencies for the entire network of 82000 providers provider groups and facilities to ensure precise provider demographic information that persist throughout Priority Health eco system to ensure correct pay out of the yearly $40M Physician Incentive Program settlement to providers and billion dollar claims payout to providers establishes and monitors correct primary care provider to member alignment along with the compliance area ensures the accuracy of Find A Doctor and ensures IRS compliance with provider financial reporting i.e. W9.
• Supervisors and implements organizational operational efficiencies of our national provider networks. Acts as designate liaison by developing and maintaining purposeful long-term relationship with nation network account representatives manages claims repricing payment system and repricing claims activities including overall review of claims manages and ensure annual payment of multi-million dollar access fees are paid accurately and timely to all national networks.
• Monitors as well as develops policies procedures and effective controls to ensure that we are compliant with SAS70 and MAR in accordance with all corporate standards.
• Supervisory Responsibilities:
• Interviews hires and establishes performance development plans; conducts staff performance discussions.
• Provides support guidance leadership and motivation to promote maximum performance.

• Preferred Bachelors Degree or equivalent with emphasis in health care business management
• 3 years of relevant experience healthcare insurance managed care and/or comparable industry Required
• 3 years of relevant experience supervision of people and processes within an operations area Preferred
• 7 years of relevant experience in Microsoft applications including Word PowerPoint Excel and Business Objects Preferred
• 5 years of relevant experience Accreditation and/or regulatory bodies like NCQA CMS MDCH TJC etc. standards related to credentialing and/or billing and/or quality auditing requirements. Preferred
• 3 years of relevant experience Experience with provider configuration credentialing claims and/or comparable systems Preferred
• CRT-Provider Credentialing Specialist Certified (CPCS) - NAMSS National Association Medical Staff Services preferred Or
• CRT-Professional Medical Services Management Certified (CPMSM) - UNKNOWN Unknown preferred

Physical Demands

• Pallet to Waist (6 from floor) > 5 lbs: Seldom up to 10 lbs
• Waist to Waist > 5 lbs: Seldom up to 10 lbs
• Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
• Waist to Overhead > 5 lbs: Seldom up to 5 lbs
• Bilateral Carry > 5 lbs: Seldom up to 10 lbs
• Unilateral Carry > 5 lbs: Seldom up to 5 lbs
• Pushing Force > 5 lbs: Seldom up to 25 lbs
• Pulling Force > 5 lbs: Seldom up to 15 lbs
• Sitting: Frequently
• Standing: Occasionally
• Walking: Occasionally
• Forward Bend - Standing: Seldom
• Forward Bend - Sitting: Seldom
• Trunk Rotation - Standing: Seldom
• Trunk Rotation - Sitting: Seldom
• Squat: Seldom
• Supine Lying: Seldom
• Stair Climbing: Seldom
• Crawling / Kneeling: Seldom
• Driving: Seldom
• Reach - Above Shoulder: Seldom
• Reach - at Shoulder or Below: Seldom
• Handling: Occasionally
• Forceful Grip > 5 lbs: Seldom
• Forceful Pinch > 2 lbs: Seldom
• Finger/Hand Dexterity: Frequently
• Visual Acuity ¹
  None No; Seldom Yes: Seldom

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.