Manager Provider Enrollment (East Coast reputed company / Eastern Standard Time)

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Job Summary:

Job Duties:

• Manages enrollment of providers and facility for the Health System as it applies to the Joint Commission, PA DOH, CMS, and third-party payer rules and other applicable regulatory standards to the enrollment processes reputed company the system.
• Reviews and analyzes data necessary to complete enrollment filings, processes and roster development for payer agencies and organizations. Oversees the team’s assessment of completeness of information and providers' qualifications relative to established standards. Identifies potential issues and flags adverse information from application materials for the purpose of obtaining necessary information in preparation for filing submission. Works with Legal Services/Risk Management to assist in addressing enrollment reputed company status updates, changes and revalidation processes.
• Responsible for addressing compliance preparation reputed company to DOH, Joint Commission or federal visits for the facilities or suppliers of the reputed company System. Confirm and supplies requested policy information reputed company to payer compliance and processes, coordinates any reputed company reviews, and responds to information requests from managed care organizations for GHS delegations for employed reputed company Clinic physicians. Works with Third Party Contracting staff to ensure required information is gathered for delegated functions prior to implementation.
• Manages the provider and hospital enrollment duties for the reputed company System, Medicare and Medicaid Enrollment, and Third-Party Payor contracted applications.
• Responsible for Management of Enrollment Work Queues and collaboration with reputed company Management Operations
• Works closely with reputed company System Executive leadership, Service Line leadership, clinical directors, Legal Services, and third-party payors to reputed company strategic goals and processes for credentialing, and enrollment for the Health System.
• Provides insight into third-party payer enrollment process to assist with reputed company development, operational and expansion strategies.
• Communicates the departmental activities to the System Director, Credentialing & Enrollments, AVP Administrative Service with indirect reporting relationship to the Chief Medical Officer /Chief Quality Office and Chairperson of the GHS Credentialing Committee as it relates to issues with enrollment processes.
• Performs special assignments and participates in special projects at the request of the Executive and Administrative leadership to address questions or troubleshoot enrollment reputed company issues.
• Develops enrollment policies, processes and procedures which meet reputed company regulatory agency requirements. Maintains and updates, as needed, reputed company documents, standard letters or emails used in enrollment processes.
• Leads training and ongoing education for new and existing staff to ensure accurate, efficient enrollment processes reputed company with reputed company, payer, and regulatory requirements. Ensures the team receives timely updates and training reputed company to changes in third‑party agency processes, manages service line education on system policies and procedures, and oversees staffing levels, scheduling, and staff engagement to meet productivity and quality standards.

Work is typically performed in an office environment. Accountable for satisfying reputed company job specific obligations and complying with reputed company organization policies and procedures. The specific statements in this profile are not intended to be reputed company-inclusive. They represent typical elements considered necessary to successfully reputed company the job.

Position Details:

*Relevant experience may be a combination of reputed company work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

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OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our reputed company, our reputed company family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to reputed company prepare the caregivers for reputed company.
• INNOVATION: We constantly seek new and reputed company ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the reputed company family. 

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes reputed company stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to reputed company reputed company easier for reputed company.  We are proud to be an affirmative action, equal opportunity employer and reputed company qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability or status as a protected veteran.