Job Description Under general supervision, is responsible for management of the functions and services directed to the enrollment of participating providers in government systems, including initial applications and revalidations. The position also oversees the assessment of the various workflow processes involved in enrollment, and creates and executes on a plan for provider enrollment improvements and updates. Responsibilities include gathering appropriate information to guide program implementation and assessment, identifying and collaborating with key stakeholders, and synthesizing highly complex information. Independently develops sustainable processes and establishes their structural foundations within the medical system. Serves as key resource for enrollment program compliance and process improvement initiatives
Principle Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
Manages a health system level service for enrollment of employed providers, facilities and other entities within UMMS with governmental payers for purposes of claims submission.
Collects, monitor and analyzes the enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement.
Participates in acquisition/integration teams and oversees the enrollment related responsibilities of onboarding new individual providers, provider groups or service line/facilities.
Effectively collaborates with and serves as primary point of contact for all UMMS enrollment stakeholders including senior leaders (affiliate CFOs), payer contracting, compliance, legal, central billing office, independent providers/administration staff, and hospital medical staff offices when necessary.
Responsible for quality control content and completeness of provider data within the enrollment software system.
Creates effective training programs, policies, and processes to ensure best practice adoption.
Implements and maintains a shared file for enrollments.
Develops, maintains, updates and oversees policy and procedures of the enrollment function. This includes development and updating of policy and procedure manuals and development of enrollment procedures with 3rd party payers and internal partners.
Tracks progress and implements quality improvement of enrollment operations, ensuring that payor enrollment is completed within required time frames to ensure optimal revenue capture.
Develops goals to reduce the enrollment processing time in areas UMMS can directly control.
Develop a best practices system for enrollment. Continuously streamlines processes and develops a system to track work output.
Oversees quarterly reconciliation of provider lists and binding authority documentation to ensure adequate enrollment procedures for payers.
Assesses the various workflow processes involved in enrollment, and creates and executes on a plan for enrollment system improvements and updates within the provider enrollment IT systems and others in use at the organization.
Company Description The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.
Qualifications
Education and Experience
Bachelor's degree in Finance, Business, IT, Health Care Administration or a related discipline; or equivalent combination of education certifications and work experience is required.
Five (5) years of experience is required which includes 1-2 years hands-on experience in payor enrollment, provider enrollment, contracting or credentialing, and 2-3 years of experience in claims processing, provider billing, revenue cycle or related work.
Government payer experience is preferred.
Multi-specialty experience ideal.
Knowledge, Skills and Abilities
Demonstrated ability to work with professional, multi-disciplinary teams as a group leader as well as a participant.
Demonstrated expertise in healthcare payer contracting, enrollment and/or billing.
Knowledge of health care and managed care delivery systems.
Proficiency in standard computer applications including MS Office suite applications.
Ability to work effectively and improvise when approached with immediate deadlines and unprompted changes to project plan.
Demonstrated ability to think strategically. Demonstrate sufficient understanding of some functions to structure and manage project work. Generate innovative and practical solutions to complex or unusual problems.
Highly effective verbal and written communication skills are necessary in order to work with all levels within the organization, and produce clear and concise reports of relatively complicated issues.
Additional Information All your information will be kept confidential according to EEO guidelines.
