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Lead Provider Enrollment Specialist in Knoxville, TN at TeamHealth

Date Posted: 9/4/2019

Job Snapshot

Job Description

Under supervision of the Provider Enrollment Managers, the Lead Provider Enrollment Specialist oversees and directs the day-to-day activities of the provider enrollment team in support of department and organizational goals. Provider Enrollment is an integral part of a successful Revenue Cycle Operation and the Organization’s ability to meet financial goals, impacts patient satisfaction, and client retention.

 ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Develop and maintain relationships with payers, clients, Corporate Managed Care to promote prompt resolution/leveraging of existing relationships to resolve open enrollment issues.
  • Complete payer research for new payers, new state requirements, and ensure guidelines are known and train department members on same.
  • Monitor accuracy of applications in ApGen and submit/manage changes as needed.
  • Submit, track, follow up on need for and requests of retroactive consideration and prepare adjustment approvals.
  • Serve as quality auditor for group and individual applications.
  • Monitor group provider enrollment mailbox and proactively manage deficiencies. Determine root cause of deficiencies, implement corrective actions, document receipt of, ensure timely and accurate resolution of same.
  • Support continuous improvement and automation of provider enrollment processes by collaborating with various stakeholders to develop new or enhance existing techniques, policies and procedures.
  • Serve as back up to Roles 1, 2, or 3 as needed.
  • Other duties as assigned.

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:             

 

  • 3+ years supervisory/lead experience preferred.
  • 3+ years of provider enrollment/revenue cycle experience preferred.
  • Demonstrated ability to work effectively across the revenue cycle, operations, and IT to promote positive change.
  • Excellent organizational abilities.
  • Ability to prioritize tasks and projects.
  • High degrees of judgement and independent decision-making, analytical evaluation, critical thinking, and problem solving skills.
  • Ability to maintain professionalism and composure.
  • Excellent written and oral communication skills.
  • Ability to multi-task and prioritize workload in fast paced, evolving environment.
  • Ability to work independently and remotely and exercise sound judgement related to when to act independently and when to escalate issues.
  • Proficient with Microsoft software.

PHYSICAL / ENVIRONMENTAL DEMANDS:

 

  • General office environment.
  • Job performed in a well-lighted, modern office setting;
  • Occasional lifting/carrying (10 pounds or less);
  • Prolonged sitting; with prolonged work in a computer/PC;
  • Occasional work in evenings and on weekends;
  • Moderate stress;
  • May require moderate overnight travel;
  • Overtime may be required and can be mandated by Management.
  • Ability to work well in fast-paced environment.

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

 

DISCLAIMER:

The above information on this description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.