Provider Enrollment Manager

MedData is among the nation’s leading providers of medical billing services. For over 3​5 years, MedData has solidified its leadership position within the billing sector by expanding upon and redefining the typical revenue cycle management processes of coding, billing, and collections. 

MedData serves ​5,000 physicians across a growing network of 1,000+ facilities throughout the U.S., having built a national presence by becoming experts at the state level. To date, we have handled billing for more than ​200 million patients. 

JOB SUMMARY
Under direction of the Director of AR Support Services, the Provider Enrollment Manager is responsible for the overall administration of the provider enrollment processes for all clients. As well as oversee process, work and team members during the execution of the enrollment process.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Oversee all aspects of the provider enrollment process.
• Monitors provider holds by prioritizing a focus on clients with large dollars impacted and get these resolved.
• Effectively works with the offshore vendors to identify any issues that might have an impact on cash flow and effectively communicate this to the Director of AR Support Services in a prompt & timely manner.
• Under direction of the Director of AR Support Services, draft new policies, train or retrain employees/vendors, immediately correcting previous errors, and monitoring ongoing compliance with policies.
• Maintain audit results and report these to the Director of the department.
• Create and maintain all the training documents.
• Ensure quality accounts receivable results by achieving or exceeding customary key performance indicators, such as A/R days holding, provider holding, etc. for the department.
• Manage provider enrollment team resources and workflow to reach maximum efficiency and productivity levels, as well as provide solutions on how to improve in this area.
• Participate and ensure successful results of all practices, and compliance with all company policies and procedures.
• Review, identify insurance carrier trends related to each team members assigned clients and resolve any related revenue and enrollment issues.
• Report all identified enrollment, carrier and revenue impacted trends and issues to the Director of AR Support Services and help create Policies & Procedures that will help resolve the issues proactively.
• Work with other Departments (i.e. Coding, AR, IT, etc.) to minimize and/or resolve ongoing procedural problems affecting Client satisfaction/quality standards.
• Promptly inform the Director of AR Support Services of any matters that may cause a disruption to the Client (s).
• Monitor the overall performance of the enrollment team on a daily, weekly, monthly basis.
• Initiate, monitor and ensure accuracy of process changes for each client and/or PE Specialist in a timely fashion.
• Communicate enrollment status to those involved on an as needed basis.
• Help resolve issues related to provider or NPI numbers.
• Deactivation of provider numbers, effective dates, NPI related denials, NPI website, etc.
• Manage state and client master applications.
• Manage team’s PTO request to ensure full department coverage.
• Give the team direction and help with prioritizing.
• Complete special project assigned by the Director of AR Support Services.
• Comply with MedData’s safety policies and procedures.
• Maintains the confidentiality of information.
• Performs other related duties as assigned.

QUALIFICATIONS AND REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

• Five plus years management experience in which problem solving and research were major keys to success.
• Knowledge of provider enrollment processes and requirements for commercial insurance companies, CMS Federal and State Guidelines related to enrollment and reenrollment policies, preferred.
• Knowledge of accounts receivable and revenue cycle management, preferred
• Familiar with group and provider documents, i.e. medical licenses, medical school practices, board certifications, etc.
• Ability to work independently and make sound and timely decisions is a must.
• Ability to identify patterns, make informed decisions, correctly identifying root causes to determine appropriate actions and outcomes.
• Ability to interact with tact and diplomacy with individuals from a variety of backgrounds and organizational levels.
• Ability to effectively communicate both in writing and verbally, as well as to interact in a professional manner with colleagues, patients, public, and client’s staff members.
• Ability to multi-task; excellent organizational and planning skills required.
• Ability to: Interpret and analyze data, multitask, work independently, prioritize, troubleshoot, problem solve, direct others, communicate clearly with tact at all levels within the organization both internally and externally, expand ideas and though processes with global approach in all areas of Provider Enrollment and AR. Independent decision making is critical.
• Strong analytical and problem solving skills.
• Excellent organizational, planning, and prioritization skills.
• Demonstrated PC skills, i.e. proficient with MS Office products including Word, Excel, Project Management, Power Point and Outlook.
• Familiar with the Internet; able to do in-depth searches to find specific websites, guidelines and instructions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

MedData is an Equal Opportunity Employer