Healthcare Enrollment Manager

Job Description

Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

JOB SUMMARY:

Serves as a company resource for Part A enrollment requirements for hospitals, home health agencies, rural health clinics and DME for payers such as Medicare, Medicaid and Fed Workers Comp. Responsible for research, completion, submission and follow up of applications required to obtain provider numbers and participation in governmental programs. Maintains working relationships with governmental agencies and healthcare facilities, obtaining any necessary information to ensure timely processing and filing of initial and renewal applications. Works with agencies, vendors and healthcare facilities to coordinate and implement electronic business office systems such as electronic billing systems, electronic remittance advice posting and electronic funds transfer.

Duties and Responsibilities:

• Complete 855A applications and EFT for new acquisitions & mergers, submit to FI and follow through with the state & CMS until Tie-in Notice is received and setup is completed with FI.

• Complete 855A applications and EFT for change of information for DPU, Provide-Based RHC, ASC, and Acute Care and follow through until completion with the FI, State and CMS.

• Completed 855A Sellers to report divestitures

• Complete 855A to report hospital, sub-unit closures

• Assist facilities in completing Disclosure of Ownership as needed for managed care payers

• Complete ALL In-state Medicaid re-credentialing applications as needed for hospitals, sub-units, RHC's, ASC's, and any other Provider Based enrollments

• Complete In-state Medicaid applications for acquisitions, mergers and follow through until the enrollment is complete

• In-state Medicaid-submit letters from legal counsel regarding divestitures or closures of hospitals or sub-units

• Complete In-state Medicaid changes of information for hospitals, sub-units, provider based RHC's, and all other provider based enrollments. Follow through until the updates are completed

• Complete In-state Medicaid updates for license, FDA mammography, Joint Commission, CLIA.

• Assist with Out-of State enrollments to cover claims and follow through until enrollment completed

• Assist with Out-of State revalidations and updates and follow through until reval or update is complete

• Apply for any NPI numbers as needed for new acquisitions or DPU additions and relate these back to the facility in order for them to append for billing purposes.

• Maintain NPPES accounts current

• Complete Medicare/Medicaid status chart monthly in order to update management on status of applications.

• Act as the liaison between CHS facilities, State Agencies and MAC/CMS to facilitate prompt resolutions of issues at hand

• Complete re-validation as required by CMS for all facilities, including their subparts units, RHC and other provider based departments

• Work closely with legal counsel, hospital administration and state agencies to ensure processing of enrollment applications.

• Maintenance of all facets of Medicare/Medicaid enrollment and re-credentialing

• Communicate with hospital administration or designated contact of needed paperwork to begin initial application or revalidations

• Responsible for all data entry to the credentialing database Vistar

• Scan all related enrollment data to Vistar

• Maintenance and filing of all paper files

• Maintain all facility licensure documents current and on file in Vistar

• Perform regular follow up on outstanding applications

• Participate in conference calls as needed for new and ongoing projects.

• Work with the treasury department to maintain facility bank information.

• Complete 855A & Medicaid applications for CHOI during internal organizational restructuring

• Complete 855A & Medicaid applications for CHOI during market facility re-branding

• Complete 855A & Medicaid for corporate CHS officer/director changes , as well as facility administrator

• Maintain Medicare file updated for facilities having a Syndication /Physician Ownership

• Other assigned duties

• Chain affiliation listing-maintain current listing by deleting closed or divested facilities and adding new facilities and sub-units and merging information on hospitals that have merged together.

• Hospital acquisitions and divestiture lising-update spreadsheet showing all closures, mergers and divestitures.

• Management responsibilities for Direct report person(s)

• Manage time off requests

• Review, sign and submit payroll exception reports to Director

• Review productivity reports daily or at least weekly

• Assist with out of state enrollments as needed

• Assist in problem solving

• Perform yearly performance reviews

• Check with direct report on workflow and concerns to make sure they are able to keep up with the workflow demands

Education: Associates Degree or 2 years of directly applicable experience required

Qualifications:

• Minimum of 5 years experience in a healthcare enrollment setting

• Must be proficient in MS Word and MS Excel

• Excellent written and verbal communication skills required

• Excellent organizational skills required

• Must be capable of independent thought and judgment

• Must be detail oriented and possess strong time management skills

Physical Demands:

In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:

• The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.

• The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.

• The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office or administrative work.