Provider Enrollment Program Director

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Under the direction of the Executive Director of Centralized Credentialing, the Director of Provider Enrollment will be responsible for developing, organizing, implementing and managing projects assigned to enhance productivity and reduce or redirect expenditures for the Johns Hopkins University Clinical Practice Association (CPA), Johns Hopkins Physical Medicine and Rehabilitation, Johns Hopkins Regional Physicians, and Johns Hopkins Community Physicians. This position will develop and maintain efficient workflows with the clinical departments, Medical Staff Offices, providers and payers for timely enrollments.

Duties include developing and writing policies and procedures for related units of responsibility and providing management oversight for the Provider Enrollment Department.

The Johns Hopkins Health System Corporation is a not-for-profit organization dedicated to providing the highest quality of care in the treatment and prevention of human illness. JHHS is an academically based health system consisting of:
The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Johns Hopkins Howard County Medical Center, Suburban Hospital, Sibley Memorial Hospital, The Johns Hopkins All Children's Health System, Johns Hopkins Community Physicians, The Johns Hopkins Medical Services Corporation and Johns Hopkins Medical Management Corporation.

Essential Functions

• Retain a comprehensive knowledge of the complex insurance regulations, laws and contracts affecting the revenue operations of the Clinical Practice Association as it relates to provider enrollment activities.
• Establish and maintain a working relationship with insurers and implement enrollment policies and procedures to ensure JHUSOM, JHRP, JHCP, JHH Physical Medicine and Rehabilitation are aligned with access to care and provider reimbursement.
• Prepare workflow and efficiency recommendations for review by the Senior Director, Professional Billing, clinical department administrators and entities, and Executive Director Centralized Credentialing Office.
• Develops meaningful oversight reports and tools to illustrate payer enrollment performances, maintain unit productivity.
  • Proactively research, interpret, and communicate complex provider enrollment guidelines and specifications that impact accurate claims submission, payments, and appeals that affect PBS operations and the filing and reimbursement of claims for numerous Production Billing Unit Specialties.
  • Monitor billing, referring and ordering, and prescribing provider enrollment time-lines, edit resolutions, and enrollment team productivity.
  • Represents the Clinical Practice Association in developing relationships with Production Unit Managers, Administrators, and other credentialing and external units to expedite and improve enrollment information accuracy.
  • Facilitate PECOS/E-Prep processes and approvals.
  • Continually look for process improvements and target problem areas and identify what needs to occur to ensure staff works effectively as a team and errors are minimized.
  • Continue to update and develop billing policies, instructions, and job-aides for increased team member understanding, compliance, and ease of use.
  • Establish procedures, measures and reporting tools to enhance standards and productivity within credentialing database.
• Monitor staff performance in credentialing database via creation of KPIs and reports.

Education

Bachelor's degree in healthcare or business-related field required. Master's degree highly preferred.

Knowledge, Skills, and Abilities:

* Recent experience and subject matter expertise with Medicare, Medicaid, and commercial payer regulations required.

* Knowledge and expertise with EPIC PB Resolute required.

* Comprehensive knowledge of and compliance with HIPAA rules and regulations regarding the dissemination of patient Protected Health Information (PHI).

* Thorough understanding of clinical practice management, medical billing, and the unique customer service requirements related to patients, physicians, and administrative staff in a high-volume medical services environment.

* Detailed knowledge of payer and government enrollment policies, credentialing, and medical staff privileges that affect billing and revenue cycle…