Supervisor, Provider Enrollment

Role Description

Participates in the selection, hiring, onboarding, and training of new employees that will positively impact and bring value to Vituity.

• Partners with other Provider Enrollment Supervisors, Managers, and Sr. Director to provide ongoing guidance, assistance, and coaching to the team.
• Evaluates team performance and discusses career goals with each team member.
• Promotes professional growth, development, and education of team members through offering new challenges, developmental assignments, offering timely feedback, regular 1:1 discussions, and mentoring.
• Uses outstanding relationship-building, communication, coaching, and development skills to effectively lead a remote team while maintaining a focus on Vituity culture, team connection, and high performance.
• Helps support excellent time management and preparedness by assisting the team with scheduling tasks out a minimum of 4 weeks into the future, and sometimes years in advance.
• Oversees a team that processes provider enrollment for a specific clinical service, geographic market, or function.
• Monitors and audits the preparation, submission, and approval of subteam’s provider enrollment applications, which can easily exceed 10,000 applications per year.
• Maintains strong knowledge of payer processes across multiple states and may have a subteam responsible for upwards of 150 payers.
• Implements and maintains operational workflows, policies, standard operating procedures, and necessary documentation practices.
• Consistently uses department and individual performance reports to ensure that the team is continually performing at optimum levels, and reviews for trends or results that may require intervention or re-direction of department activities or processes.
• Using data and analytics, analyzes issues, diagnoses problems, and identifies process improvement opportunities to propose solutions, with input from Provider Enrollment Manager and Sr. Director.
• Utilizes and trains subteam on multiple Salesforce functions, including Data Loader, Dynamic Document Package (DDP), dashboards, and reporting.
• Uses multiple platforms such as SharePoint, Wrike, Teams, and Outlook as needed.
• Project manages new startups and opportunities.
• Attends internal startup calls and identifies any areas of concern to discuss with Provider Enrollment Manager and/or Sr. Director.
• Researches new payer requirements to help the team implement new provider enrollment processes and workflows.
• Maximizes team resources and workflows to increase efficiency and productivity.
• Understands revenue cycle process and how provider enrollment greatly impacts Vituity revenue.
• Reinforces best practice deadlines that the team strives to reduce A/R aging so that siteline revenue is received quicker.
• Develops trending reports to identify areas of opportunity.
• Plans, evaluates, and improves the efficiency of business processes to enhance speed, quality, timeliness, and output.
• Identifies and researches payer issues proactively and collaborates with RCM Denial Team on any payer or reimbursement issues due to provider enrollment.
• Builds partnerships and relationships with payers across the nation to support Vituity’s provider enrollment goals and opportunities.
• Collaborates with Vituity Client Service Managers, Payer Contracting team members, site leadership, and other stakeholders to identify trends in payer reimbursement and protect Vituity’s revenue.
• Works and communicates cross functionally with other department supervisors to ensure efficiency and promote collaboration.
• Plans and leads internal team meetings and records meeting minutes.
• Reports difficulties, obstacles, risks, and delays in enrollment to Vituity leadership.
• Complies with federal, state, and national regulations and requirements to ensure Vituity is in compliance with all payer regulations and to minimize and control organizational risks.
• Analyzes and reviews the language of new payer enrollment requirements, and works with other Provider Enrollment Supervisors, Managers, and Sr. Director to ensure requirements are communicated downstream.
• Uses knowledge of Vituity Legal and Finance data to report changes in entity structure or finances to payers on an annual or as needed basis.
• Keeps current on provider enrollment trends at the state and national level and attends state and national PE conferences as needed.

Qualifications

• High school diploma or equivalent required.
• 1-2 years of experience leading projects/teams in healthcare required.
• 5 years of experience in healthcare with a thorough understanding of payers and provider enrollment process required.
• Bachelor’s degree preferred.
• Experience and demonstrated ability with Provider Enrollment functions in a healthcare setting preferred.
• Working knowledge of Salesforce, Provider Enrollment, Chain, and Ownership System (PECOS); Council for Affordable Quality Healthcare (CAQH); and Provider Application and Validation for Enrollment (PAVE) preferred.
• Billing or reimbursement experience preferred.
• Ability to interact effectively with practitioners, insurance representatives, internal departments, and team members.
• Proficiency with Microsoft Office, with a high degree of speed and accuracy in typing.
• Strong attention to detail.
• Strong time management and organization required.
• Strong interpersonal skills, ability to work as part of a team.
• Strong problem resolution skills.
• Ability to effectively interact with providers, payer representatives, internal departments, team members, and other stakeholders, both in written and verbal communication.
• Proficient in Microsoft Office Suite (Teams, Outlook, PowerPoint, Word, Excel, OneNote, OneDrive).
• Knowledge of laws and regulations regarding enrollment processing in multiple states.
• Knowledge of online Medicare/MediCal/Medicaid enrollment system, Identify & Access system, Counsel For Affordable Quality Healthcare system, Medicare enrollment specialties and National Provider Identifier taxonomies.
• Knowledge of Salesforce (including Data Loader, DDP, and reporting).
• Ability to accomplish tasks thoroughly and accurately.
• Ability to effectively manage time and organize.
• Knowledge of Medicaid enrollment process, including revalidations, medical license expirations, deactivations, NPI taxonomy importance, how data flows to Medicaid managed cares, Medicaid billing manual, state administrative codes, border state enrollment process, out of state enrollment process.
• Knowledge of billing processes, including timely filing and claims denial reasons.
• Demonstrate strong project management skills, including formal usage of project management tools, Utilizing Responsible Accountable Consultant Informed (RACI) and other project management techniques, agendas, action item lists, project checklist, desired outcomes, measures of success.
• Utilize strong critical thinking skills to deeply analyze problems and find a timely solution with the best chance of long term success.

Benefits

• Superior health plan options.
• Dental, Vision, HSA/FSA, Life and AD&D coverage, and more.
• Top Tier 401(k) retirement savings plans that offers a $1.20 match for every dollar up to 6% plus discretionary profit-sharing contributions (eligible January following 18 months of service).
• Generous paid time off starting 3-4 weeks’ annually.
• Student Loan Refinancing Discounts.
• Professional and Career Development Program.
• EAP and travel assistance included.
• Wellness program.
• Purpose-driven culture focused on improving the lives of our patients, communities, and employees.