JOB PURPOSE: Leads and directs the system-wide provider enrollment process for employed providers and independent Piedmont Clinic providers.
1. Directs a health system level service for enrollment of employed providers and independent Piedmont Clinic providers with both governmental and commercial payers for purposes of claims submission.
2. Provides direct leadership and management for provider enrollment team members.
3. Recruits, hires, and develops staff as needed to support an effective enrollment infrastructure.
4. Creates effective training programs, policies, and processes to ensure best practice adoption.
5. Develops the annual enrollment department budget and as necessary, strategic initiatives aligning with Piedmonts overall strategic plan.
6. Creates and fosters a culture of customer service within the enrollment department to better serve all stakeholders.
7. Participates on acquisition / integration teams and oversees the enrollment related responsibilities of onboarding new individual providers and provider groups.
8. Develops actionable plans to scale enrollment services to maintain high customer service given changing workload demand.
9. Participates in the administration of the credentialing / enrollment software system.
10. Responsible for quality control of content and completeness of provider data within the credentialing / enrollment software system.
11. Collects, monitors, and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement.
12. Focuses on enrollment related continuous process improvement to ensure optimal operation.
13. Effectively collaborates with and serves as the primary point of contact for all Piedmont enrollment stakeholders including senior leaders, managed care, central billing office, independent providers / administration staff, central verification office, and hospital medical staff offices.
14. Establishes and maintains strong and mutually beneficial relationships with all participating health plans and serves as the primary point of contact for provider enrollment related topics with all applicable third party payer representatives.
15. Conducts regular communication with payers including quarterly distribution and reconciliation of provider rosters.
MINIMUM EDUCATION REQUIRED:
Bachelors degree in Healthcare Administration, Business Administration, or a closely related field.
MINIMUM EXPERIENCE REQUIRED:
Seven (7) years of progressive healthcare experience including a minimum of two (2) years of credentialing/provider enrollment experience in a hospital, multi-provider ambulatory practice, or third-party payer setting.
Three (3) years of management/leadership experience.
Masters degree in Healthcare Administration, Business Administration or a closely related field is preferred.
Experience with enrollment/credentialing database software is desired.
Certification through NAMSS as Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional in Medical Services Management (CPMSM) is preferred.