Supervisor, Provider Enrollment

About the role

Reporting to the Director, Provider Enrollment and Network Relations, the Supervisors of Provider Enrollment are responsible for the processing and coordination of all provider enrollment transactions. They assure the enrollment team delivers quality services in accordance with BILPN’s mission and with all applicable policies, procedures, and professional standards. The Supervisors monitor both internal and external relationships with health plans, providers and escalated inquiries, and deploy suggested improvements in policy and enrollment processes and the systems that support them to ensure compliance with internal and external standards and to improve efficiency. They are also responsible for initial and ongoing training and educational opportunities for enrollment staff, and continued maintenance of training materials. The Supervisors operate as the main lead on internal cross-functional teams within BILPN.

Responsibilities

• Provide daily ongoing supervision and feedback to the BILPN enrollment team.
• Supervise, maintain, update, and oversee policy and procedures of the enrollment function, including enrollment procedures with payors and internal partners.
• Maintain and track delegated credentialing agreements; coordinate with PSA on delegation audits for health plans.
• Manage required contractual notifications to payors pertaining to specific providers and apply stringent confidentiality standards with regard to same.
• Assist the director on tracking performance metrics and implement quality initiatives to enrollment operations; ensure enrollment with payors is completed within required time frames to ensure optimal revenue capture.
• Assure BILPN compliance with regards to enrollment criteria in payor contracts; responsible for understanding the provider information needed for risk contracting.
• Oversee quarterly reconciliation of provider lists and binding authority documentation to ensure adequate enrollment procedures for payors.
• Assist on the distribution, collection, and tracking of participating provider agreements and any related amendments.
• Assist the director on managing the relationships with payors to identify and resolve operational issues between providers and payors that affect enrollment, practice operations, or revenue capture; ensure health plan enrollment occurs in a timely manner.
• Identify and resolve payor or enrollment related issues that impact the BILPN network and build strong customer relationships—both internal and external—and deliver solutions that meet customer expectations.
• Assist, as needed, the coordination of cross-functional projects relating to provider and hospital data; represent BILPN to various internal and external committees.
• Assist the director on developing educational programs for participating providers in response to new legislative directives (e.g., HIPAA, Medicare Reform Act, NPI).
• Develop new administrative processes within BILPN and in concert with practices to ensure that providers comply with these new enrollment requirements.
• Have the authority to direct and support employees’ daily work activities and the direct responsibility to undertake employment actions including hiring, termination, corrective action, and performance reviews.

Required Qualifications

• High School diploma or GED required; Bachelor’s degree preferred.
• 3–5 years of related work experience required, including 0–1 years of supervisory/management experience.
• 3–5 years of related work experience in physician group practice management, provider enrollment relations, contract management, or credentialing.
• Knowledge of Medicare, Medicaid, and behavioral health provider enrollment.
• Advanced skills with Microsoft applications (e.g., Outlook, Word, Excel, PowerPoint, Access) and other web-based applications; ability to produce complex documents, perform analysis, and maintain databases.

Pay

The pay range for this position is $67,995.00 USD – $130,000.00 USD annually. Actual compensation is determined based on several factors including seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.