Supervisor, Provider Enroll/Cred BHS

Job description

Reports to the Manager, ACO & Credentialing. The role provides direct supervision for provider enrollment, CVO, CHA and ACO credentialing representatives. Responsible for ensuring the timely completion of initial and re-credentialing processes for Beacon Health System, Community Health Alliance (CHA), and Credentialing Verification Organization (CVO Alliance) contracted providers. Coordinates efforts with physicians and providers (employed or contracted), credentialing agencies, regulatory agencies, payors, and office managers to complete the credentialing and enrollment process in accordance with the National Committee on Quality Assurance (NCQA) standards and departmental policies and procedures. Develops systems to review applications for provider and facility credentialing.
MISSION, VALUES and SERVICE GOALS
• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Supervision/Administrative Duties:
• Supervise the team members in the credentialing and provider enrollment department.
• Complete performance reviews and provide ongoing training and feedback to team members.
• Perform file audits as requested by the payers.
• Schedule & perform delegation audits on behalf of CHA and CVO Alliance in a timely and accurate manner.
• Serve as a liaison and communicate with the Physician Recruitment team (BMG).
• Monitor closely the status of the team worklogs and report delays/concerns/non-compliance to appropriate internal and external contacts before the assigned start date.
• Monitor information entered in the credentialing database for accuracy.
• Provide timely reports as requested.
• Assist Beacon Medical Group, and the hospitals Patient Accounts departments with network and claim issues related to credentialing.
• Monitor monthly the OIG/IPLA sites for potential litigation for a Beacon Health System Provider. Notify payors and manager of any findings.
• Oversee and coordinate special projects throughout the year that impact the team (i.e. COI and license renewals).
• Prepare and submit invoices for CVO clients.
• Maintain and monitor policies and procedure as they relate to credentialing/provider enrollment.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by completing/working at least 1 file for CVO, Credentialing and enrollment monthly:
Enrollment
• Monitor appropriate web-sites for information relevant to credentialing/enrollment and share Information with team members and department leaders.
• Notify various entities of the physicians and providers effective and termination dates.
• Coordinate with the hospital Patient Accounts department to enroll the hospitals and providers in out-of-state Medicaid plans.
• Educate new physicians and providers, along with the BMG residents, on the importance of credentialing and providing information timely to process licensure, applications, etc., and satisfy deadlines.
• Maintain provider's CAQH profile and provide updated and accurate information as required.
• Serve as an administrator for payors and insurance companies websites to provide maintenance of Beacon Health System physicians and providers information.
• Apply for and maintain Beacon Health System physician and provider NPPES (National Plan & Provider Enumeration System) identifier.

Credentialing
• Coordinate efforts with outside credentialing agencies, regulatory agencies, payors, office managers, and contracted providers to obtain information needed for the credentialing process.
• Oversee and at times, complete the credentialing process in accordance with NCQA/payor standards and departmental policies and procedures.
• Serve as a liaison and communicate with the CHA Medical Director and hospital Medical Staff coordinators on credentialing status.

ORGANIZATIONAL RESPONSIBILITIES
Associate complies with the following organizational requirements:
• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience
• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of an Associate's Degree or Bachelor's Degree in Business, Health Administration or a related field. Three years of related credentialing experience and/or supervisory experience in the healthcare or health insurance industry is required.

Knowledge & Skills
• Requires a working knowledge of federal, state and local laws and NCQA standards applicable to assigned areas of responsibility.
• Demonstrates the analytical, problem-solving and organization skills necessary to develop and implement methods and procedures for improving and facilitating the credentialing and enrollment processes.
• Requires solid office skills (including the ability to take minutes at meetings) and the ability to operate standard office equipment. Also requires basic math skills.
• Demonstrates proficient computer skills (data entry, word processing and spreadsheets). A basic understanding of database applications is desired.
• Demonstrates excellent communication skills (both verbal and written).
• Requires the interpersonal skills necessary to interact effectively with a wide variety of internal and external contacts.
• Requires the ability to develop and maintain effective working relationships.

Working Conditions
• Works in an office environment.
• Requires the ability to work flexible hours, which may vary according to the department's needs.

Physical Demands
• Requires the physical ability and stamina to perform the essential functions of the position.