Company :Allegheny Health Network
Job Description :
Primarily responsible for the direct supervision of staff within the Provider Enrollment Department at AHN. Assists in the management of daily operational processes including optimization of work, projects, Human Resources and provides support for provider enrollment functions, including special projects within the department. Identifies workflow issues, solutions, training needs, works special projects, identifies and assists with resolution as needed. Monitors daily workflow and reassigns work as needed. Facilitates and cultivates a teamwork environment.
- Supervises staff, evaluates work and current state results, monitors staff time and makes appropriate recommendations as needed. Continuously searches for process improvements to achieve accuracy and departmental efficiencies. (35%)
- Uses problem solving skills and planning abilities to evaluate and solve root causes relative to payer enrollment functions, credentialing software and tasks associated with AHN/AC Delegated payer credentialing contracts. (25%)
- Organizes, delegates, monitors and measures special projects to ensure that they are completed timely and accurately. Provides feedback on project results to management. (20%)
- Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers and others as identified. Maintains positive working relationships with provider and insurers. Proactively communicates any changes to requirements for credentialing/re-credentialing payer processes, stressing importance of compliance with these processes. (10%)
- Independently leads initiatives as assigned by management coordinating task teams or other forums to deliver results as identified and/or determined by leadership. Provides formal updates and closure. (5%)
- Develops databases and spreadsheets to tracking organizational providers. Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by manager. (5%)
- 5-7 years of experience with payer credentialing/enrollment requirements for a large multispecialty physician group or large physician network.
- Prior knowledge of professional provider enrollment /credentialing requirements for Governmental and Commercial payers.
- Experience working with payers under a Delegation Agreement.
- Associate’s degree in Business or Healthcare Administration
- Experience with Cactus or Enrollment/Credentialing software a plus
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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