Team Lead, Provider Enrollment

Job Purpose

The Team Lead, Provider Enrollment is responsible for training and oversight of offshore team members and assisting the provider enrollment manager to ensure the credentialing/enrolling of new and established health care providers and other policies/procedures of the department are being followed.

Duties and Responsibilities

• Assist in the oversight of issue resolution for the provider education process regarding application completion and submission
• Assist in the oversight of ensuring that the collection, updating and maintenance of necessary provider information and documentation is completed
• Assist in ensuring the enrollment follow-up, by client and payer, is completed within departmental and client parameters
• Ensure that provider enrollment applications for all initial applications and re-credentialing are completed in a timely and complete manner
• Assist in the oversight to ensure that verification of provider and group information with insurance companies is completed
• Assist in the coordination of information for enrollment and termination of all providers and communicate to team and clients as appropriate
• Contributes to the departmental process and procedures with a collaborative approach
• Assist in the oversight of the monitoring of provider enrollment work queues and smart feeds and other provider reports to ensure they are kept current and communicate areas of opportunities and trends to the Manager
• Assist in the training and education on enrollment processes or required research for accuracy
• Organizes, schedules and conducts all training activities of the onshore and offshore provider enrollment team as it relates to enrollment follow-up
• Documents and records training sessions to be used for future reference
• Monitors and analyzes productivity along with performing Q/A for offshore team
• Provides timely feedback to offshore provider enrollment regarding Q/A process and results
• Identify struggles with offshore provider enrollment staff and provide guidance when needed
• Performs other duties as requested
• Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• High School graduate or equivalent required
• 4 years of provider enrollment experience
• Knowledge of Microsoft Word, Outlook, Excel, CAQH
• Billing knowledge and experience preferred
• Strong organizational skills and the ability to prioritize work
• Excellent written, verbal and interpersonal skills
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.