Provider Enrollment Manager

Med Data is among the nation’s leading providers of medical billing services. For over 35 years, Med Data 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.

Med Data 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 Med Data’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,…