[Hiring] Manager Provider Enrollment @Geisinger

Role Description

Provides leadership assistance to the operations of assigned department(s). Responsible for Provider and Facility Enrollment Services.

• Manages enrollment of providers and facility for the Health System as it applies to the Joint Commission, PA DOH, CMS, and third-party payer rules and other applicable regulatory standards.
• Reviews and analyzes data necessary to complete enrollment filings, processes, and roster development for payer agencies and organizations.
• Oversees the team’s assessment of completeness of information and providers' qualifications relative to established standards.
• Identifies potential issues and flags adverse information from application materials for the purpose of obtaining necessary information in preparation for filing submission.
• Works with Legal Services/Risk Management to assist in addressing enrollment related status updates, changes, and revalidation processes.
• Responsible for addressing compliance preparation related to DOH, Joint Commission, or federal visits for the facilities or suppliers of the Geisinger System.
• Confirms and supplies requested policy information related to payer compliance and processes, coordinates oversight reviews, and responds to information requests from managed care organizations.
• Works with Third Party Contracting staff to ensure required information is gathered for delegated functions prior to implementation.
• Manages the provider and hospital enrollment duties for the Geisinger System, Medicare and Medicaid Enrollment, and Third-Party Payor contracted applications.
• Responsible for Management of Enrollment Work Queues and collaboration with Revenue Management Operations.
• Works closely with Geisinger System Executive leadership, Service Line leadership, clinical directors, Legal Services, and third-party payors to develop strategic goals and processes for credentialing and enrollment.
• Provides insight into third-party payer enrollment process to assist with Geisinger development, operational, and expansion strategies.
• Communicates departmental activities to the System Director, Credentialing & Enrollments, AVP Administrative Service, and indirectly to the Chief Medical Officer/Chief Quality Officer and Chairperson of the GHS Credentialing Committee.
• Performs special assignments and participates in special projects at the request of Executive and Administrative leadership.
• Develops enrollment policies, processes, and procedures which meet all regulatory agency requirements.
• Maintains and updates all documents, standard letters, or emails used in enrollment processes.
• Leads training and ongoing education for new and existing staff to ensure accurate, efficient enrollment processes aligned with Geisinger, payer, and regulatory requirements.
• Ensures the team receives timely updates and training related to changes in third-party agency processes.
• Manages service line education on system policies and procedures, and oversees staffing levels, scheduling, and staff engagement to meet productivity and quality standards.
• Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.

Qualifications

• Bachelor's Degree (Required)
• Minimum of 5 years relevant experience (Required)
• Minimum of 3 years Managerial/Supervisory experience (Required)

Requirements

• Acts Decisively
• Financial Analysis
• Flexibility
• Leads Others
• Organizing
• Problem Solving
• Professional Presentation

Benefits

• Healthcare benefits for full-time and part-time positions from day one, including vision and dental.
• Encouragement of an atmosphere of collaboration, cooperation, and collegiality.