About This Role
This management role is responsible for planning, organizing, and leading the functions of enrollment for Managed Care and facility credentialing. The manager leads a team that completes complex facility applications and resolves related issues. The role involves working with Operational and Revenue Cycle Leaders to identify, recommend, develop, implement, and support process improvement.
Responsibilities
- Oversee and/or maintain the Epic Database, Payor Enrollment, and Epic Billing system credentialing edits/denial work queues
- Manage applications, ensuring issues are triaged and resolved in a timely fashion
- Be responsible for all aspects of training, Epic Work queues, Managed Care Credentialing, Rosters, Echo, Workflows, and other internal processes
- Maintain materials in the One Note Provider Enrollment Manual
- Monitor volumes in work queues and reassign duties
- Assist in leading and providing oversight in operational services associated with revenue cycle, including Changes of Ownership and Name Changes, to ensure successful claims adjudication
- Oversee the development of tracking tools to analyze data to identify claim trends and ensure responsible decision-making
- Oversee claim hold work queues to ensure claims are moving out successfully
- Manage the development and implementation of policies and procedures to ensure effective operations
- Direct the development of standards of performance and mechanisms for problem resolution
- Be responsible for compliance with governmental payor standards and NCQA standards
- Plan, support, and coordinate activities to ensure project goals and objectives are accomplished within prescribed timeframes and funding parameters
- Review project proposals or plans to determine timeframe, funding limitations, procedures for accomplishing projects, staffing requirements, and allotment of available resources
- Recruit and hire departmental staff members
- Develop a departmental staff training program to ensure all employees understand departmental and System policies and procedures
- Research current education and training needs through monthly rounding
- Establish sound working relationships and cooperative arrangements with Revenue Cycle, MSO, and CVO departments and executives
- Lead and oversee Physician/Provider onboarding and special programs
- Serve as the Authorized Official within the Governmental Identity and Access System
- Assign surrogate privileges to appropriate Prisma Health employees
- Serve as Delegated Official on behalf of Prisma Health within the Governmental Medicare and Medicaid System
- Sign on behalf of the System along with the CEO, CFO, COO, and Executive Director of Revenue Cycle
