Manager, Provider Enrollment
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
Under the direction of the Senior Manager, Provider Enrollment, the Manager is responsible for the daily activities of a team of Provider Enrollment Team Leads, Provider Enrollment Specialists, and Provider Enrollment Coordinators focused on commercial and government payor enrollment activity for the assigned market(s). The Manager is hands on with the team to ensure proper support of the department.
• Ensure that the department is up to date regarding current payor enrollment requirements and processes in order to minimize enrollment delays. This includes policy and process documentation.
• Ensure the timely submission and follow up of enrollment 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.
• Actively and continuously analyzes workflows, organizational structure, staffing assignments or other factors to ensure optimal performance; makes recommendations and modifications, as necessary.
• Provide clear direction for staff by establishing goals, objectives, policies, procedures, performance improvement programs, and action plans as needed. Performs all hiring, training, coaching, auditing and evaluations of Provider Enrollment staff. Supervises enrollment staff and workflow including guidance and training for staff
• Oversee maintenance of Provider Enrollment Databases. Responsible for the timely updating in Verity, Athena, CAQH, and other applications as appropriate.
• Effectively communicate with practice management the status of the providers with the third party payers.
• Participate in the development and maintenance of the Verity system including, but not limited to, updating organizations as needed and payors as new contracts are executed or terminated, and implementing new functionalities as they are developed
• Staff training and development through supportive hands on leadership
• Workload management through planning, prioritizing, and assigning work according to shifting priorities
• Report out on team’s productivity using custom reporting to Senior Leadership
• Monitor and make decisions on assigned teams account receivable and actively participate in the monthly Bad Debt meetings and other operational revenue meetings
• Ensure the strategic plan, mission vision and values are communicated to the team and are integrated in its goals, objectives, and work.
• Work with Senior Leadership in developing new processes and procedures to improve quality and quantity of work.
• Recognize and recommend operational improvement as needed
• Assist with other departmental project assignments per management request
• Bachelor’s degree in Business Office Administration, Health Care Management or related field preferred, and 5-10 years of experience in a related field or an equivalent combination of education and experience
• Minimum 3-5 years of managerial experience in professional healthcare setting or health insurance plan provider enrollment setting required
• Experience with Verity and Athena enrollment systems preferred
• Must possess strong verbal and written communication skills
• Knowledge of third party payer requirements and guidelines
• Must possess strong analytical skills, accurate typing and computer skills; including Outlook, Excel and Word
• Able to adjust to changes and adapt to new processes
• Ability to research issues and to recommend feasible solutions
• Advanced knowledge of and ability to use computers and related software including MS Excel spreadsheet, Word, and Email