Provider Enrollment Specialist
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
This position is responsible for providing leadership and subject matter expertise in timely and accurate provider enrollment functions and processes. This position performs administrative and technical duties requiring accuracy and attention to detail in the enrollment and re-enrollment of our providers with all payor contracts that the organization is contracted with, or has an agreement with, for the reimbursement of services. This position has continuous contact with internal and external customers including physicians and other healthcare providers, administrators, support staff and network representatives. Additionally, this position is responsible for communicating provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered. As a Team Lead, this position requires a comprehensive understanding of all system applications used in the division, must be able to identify application related problems and assist in resolving. The Provider Enrollment Team Lead reports to the Provider Enrollment Manager.
ò Accurately complete the enrollment/re-enrollment processes as outlined by each division for all appropriate healthcare providers as identified through department policies and network reimbursement and delegated contracts to ensure timely and continued provider network participation.
ò Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanning of hard copy documents, and document each stage of enrollment/re-enrollment process thoroughly.
ò Timely and accurately maintain all internal systems with appropriate provider and network participation information. Systems including, but not limited to Athena and Cactus.
ò Develop and maintain good working relationships with Steward providers and support staff to obtain necessary and timely information to facilitate the provider enrollment/re-enrollment process.
ò Develop and maintain relationships with plan representatives in order to facilitate the provider enrollment/re-enrollment processes.
ò Responds to, researches, and resolves problems with provider network participation as it relates to denial of services or reimbursement by working closely with all levels of administrative and clinical personnel and network representatives.
ò Performs follow up with health plans in order to expedite participation approval by each health plan.
ò Responsible for educating providers, administrators, and support staff regarding the enrollment/re-enrollment processes and how it relates to the provider's ability to provide care to network members in order to increases reimbursement and reduce patient dissatisfaction.
ò Work collaboratively with fellow team members to create, evaluate, and maintain department workflows, processes, policies and systems. In addition to training support staff (as needed).
ò Responsible for completing analytical functions, special projects and be cross trained on running varies reports from multiple systems.
ò Independently manage and monitor daily work related to resolution of payor enrollment follow-up
ò Assist in the evaluation and recommendations of programs, procedures for improved operations, modifications to and/or implementation of new procedures.
ò Identify and work with management to resolve problems in provider enrollment processes and when appropriate, initiate changes to prevent future problems.
ò Assist in establishing long and short term unit goals and objectives to support department and corporate strategic plan.
ò Responsible for distributing work to team members.
ò Assist in training newly hired staff.
ò Maintain professional competency, according to department policies, procedures and protocols.
ò Maintain a repository of knowledge required to train new revenue cycle associates including manuals, tip sheets and other materials.
ò Maintain strict confidentiality and adheres to all HIPAA guidelines/regulations.
ò 1-2 years minimum experience in provider enrollment with specific payor(s) subject matter expertise.
ò Demonstrated ability to supervise teams or groups of colleagues.
ò Experience with provider enrollment systems. Specific Cactus and Athena experience a plus.
ò Possess ability to investigate, analyze and in coordination with management, resolve departmental issues.
ò Possess ability to work efficiently and accurately, and to organize and plan work.
ò Possess flexibility and adaptability to work additional hours and to work under stress.
ò Ability to establish and maintain effective working relationships and communicate clearly with customers both within and outside of Steward.
ò Highly detail oriented and well organized; ability to multitask.
I. Education: Associate's Degree required.
II. Experience (Type & Length): At least 1- 2 years' related experience.
III. Software/Hardware: MS Office suite.
Job Status: Full Time
Job Reference #: I55177