Manager Provider Enrollment

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Work Shift

Day

Work Day(s)

Friday, Monday, Thursday, Tuesday, Wednesday

Shift Start Time

8:30 AM

Shift End Time

5:00 PM

Worker Sub-Type

Regular

Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's.

Job Description

Provides direct management for a team that enrolls all of Children's professional providers, as well as credentialing all of Children's facilities, with commercial and governmental plans. Remains informed of governmental and accreditation credentialing requirements. Manages the flow of provider data both from, and to, payers. Participates in the administration of Children's delegation arrangements with payers. Develops process improvement solutions to better manage provider data, enhance productivity, and performance. Identifies operational gaps, risks, issues, and opportunities for efficiencies and strategies for process improvement. Responds to internal and external questions/and problems related to facility and professional credentialing and enrollment.

Experience

• Requires a minimum of 5 years of experience in commercial, Medicaid, or Medicare provider (Experience with data management may be substituted for provider data management)
• Minimum of 3 years of experience in staff management

Preferred Qualifications

• 5 years of systems related project management experience.

• Strong record of project leadership with a proven ability to track, prioritize, and drive multiple concurrent projects to completion.

Education

• Bachelor's degree in information systems, business administration, or health-related field

Certification Summary

• No professional certifications required

Knowledge, Skills, and Abilities

• Demonstrated knowledge of database management, including other reporting writing programs

• Demonstrated written/verbal communication skills

• Demonstrated teaching skills

• Strong organizational, project management, analysis, and interpersonal skills

• Ability to maintain confidentiality

• Advanced skills in Microsoft Word, Excel, and Access

• Ability to navigate various payer/resource websites and web-based applications

Job Responsibilities

• Develops and maintains integrity provider data submitted and received from payers, including but not limited to, auditing credentialling information and documentation, maintaining Children's national provider identification numbers, and validating enrollment holds.

• Develops, trains, and oversees team that enroll providers to ensure timely, efficient provider enrollment for participation in government and commercial plans.

• Prioritizes work and updates provider information monthly to applicable entities.

• Collaborates with internal and external stakeholders to account for enrollment changes.

• Develops, trains, and oversees team that credentials and enrolls facilities with commercial and governmental payers. Collaborates with Emory to enroll selected providers as ordering, prescribing, or referring providers in Georgia Medicaid and Medicare.

• Reviews all of Children's delegation agreements and makes suggestions for improvements.

• Remains informed of payer-required changes for delegation and applicable regulatory changes related to federal law, Medicaid, and Medicare.

• Troubleshoots problems related to facility credentialing and facility and provider enrollment issues.

• Participates in payer operations meetings to resolve problems related to enrollment.

• Serves as an escalation contact for problem resolution between payers and internal staff related to provider enrollment or facility credentialing and enrollment.

• Develops, distributes, coordinates, or presents education and training related to facility credentialing and facility and provider enrollment.

• Works with leadership to develop or complete strategic and business plans.

• Manages provider enrollment team, including interviewing, hiring, training, developing, directing work and processes, managing performance, recognizing, and rewarding employees.

• Mentors team members to encourage personal and professional growth and encourages ongoing skill development by providing opportunities for continued education.

• Other duties, as assigned.

Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

Primary Location Address

1575 Northeast Expy NE

Job Family

Managed Care