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Provider Enrollment Team Lead

Provider Enrollment Team Lead

Job ID 
2018-1992
# of Openings 
1
Job Locations 
US-NJ-Marlton
Posted Date 
2/20/2018

More information about this job

Overview

Position Summary

 

InSight Telepsychiatry is seeking a Provider Enrollment Team Lead to work with the medical affairs team in Marlton, NJ and connect regularly to a national team of colleagues. This position is responsible for preparing, submitting and tracking credentialing applications and supporting documentation for the purpose of enrolling providers with payers (health insurance companies). The Provider Enrollment Team Lead will ensure interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. The position is responsible for the accuracy and integrity of the credentialing database system, CAQH profile and related applications. The Provider Enrollment Team Lead will work under the supervision of the director of medical affairs, and will provider mentorship to a team of enrollment coordinators.

 

Organization Overview

 

The CFG Health Network is a family of companies that provides behavioral health services across the spectrum of care. InSight Telepsychiatry is the telemedicine arm of the CFG Health Network and has a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand, scheduled or connected services basis. With 18 years of telepsychiatry experience and an active footprint in telepsychiatry-related advocacy, InSight is recognized as an industry thought-leader. Collectively, the CFG Health Network companies share a management team and certain back-office functions. In addition to telepsychiatry, the CFG family of companies provides outpatient behavioral health services, hospital based programs including inpatient psychiatric services, ED evaluations, psychiatric crisis center intervention, medical/surgical services and healthcare services for correctional facilities.

Responsibilities

Job Responsibilities

 

Enrollment Job Processing (60%)

  • Ensure applicant eligibility by analyzing a provider’s profile and accompanying documents
  • Implement, coordinate and monitor provider enrollment and credentialing process for initial and re-credentialing applications
  • Work closely with provider to obtain missing documentation and/or signatures pertaining to enrollment
  • Confirm receipt of requested documents, identify and respond to issues that require additional investigation and evaluation, validate discrepancies with provider and facilitate process for payer participation
  • Perform timely follows-ups, maintain and update database on the status of application and to report to management and provider
  • Enter and maintain credentialing information into CFG credentialing database and CAQH profile
  • Monitor documentation expiration dates and acquire the current and updated documentation
  • Respond to inquiries from other healthcare organizations, interface with internal and external credentialing issues as they arise for enrollment and contracting matters
  • Maintain and utilize the credentialing database to optimize efficiency, perform document generation, and track and report on applicant status

 

Staff Support (20%)

  • Serve as main support and mentor to enrollment coordinators responsible for submission of new enrollment applications as well as maintenance of existing enrollments, tracking for re-enrollment or re-credentialing periods
  • Train and coach enrollment coordinators to improve their professional knowledge and skills
  • Monitor and ensure compliance with P&P and standard operating procedures
  • Assist in creating or revising workflows, procedures, policies and or standards as needed
  • Assist in assigning medical affairs jobs to the appropriate enrollment coordinator
  • Monitor and balance the workload of enrollment coordinators to ensure efficiency and maximum productivity
  • Regularly communicate updates, including expected completion dates, internally and externally
  • Assist the Medical Affairs Director in identifying barriers or challenges to timely completion of medical affairs jobs and help put solutions in place, including escalation and communication protocols

 

External/Internal Communication, Report and Special Projects (20%)

  • Serve as a liaison for medical affairs with partner counterparts
  • Meet with Medical Affairs Director and Project Manager regularly to provide updates
  • Support the Medical Affairs Director in establishing goals and benchmarks for enrollment team and regularly monitor and report on the progress of those goals
  • Support quality assurance initiatives and create an environment where QA outcomes drive performance of enrollment coordinators
  • Participate and support Credentialing Committee meetings as needed
  • Maintaining Delegated Credentialing rosters, as needed
  • Overflow of Credentialing Jobs and other duties as assigned
  • Assist medical affairs department with special projects
  • Other duties as assigned

Qualifications

Job Requirements

  • High School Diploma
  • Two years of credentialing experience
  • Outlook, Excel, PowerPoint and Word proficiency
  • Database management skills including querying, reporting and document generation
  • Ability to manage and impart confidential information
  • Independent worker
  • Organization and time management skills
  • Ability to multitask

 

Ideal Candidate

  • Previous healthcare experience
  • Working knowledge of clinical and/or hospital operations and procedures
  • Knowledge of Medicare, Medicaid and commercial payer provider enrollment process
  • Knowledge of Echo Credentialing Software
  • Knowledge of NCQA standards as it relates to credentialing and health plan enrollment
  • Strong verbal and written communication skills
  • Informational research skills

 

Logistics                                                

  • Position available March 2018
  • Full-time position based in Marlton, NJ
  • Reports to Director of Medical Affairs, Medical Affairs Manager, or authorized designee

Please include your resume and a customized cover letter with your application.

 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

While performing the duties of this job, the employee is regularly required to stand, walk, and talk or hear. The employee frequently is required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus. EOE M/V/F/D