Supervisor, Payer Enrollment & Reporting

Job not on LinkedIn

🔥 0 minutes ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Oversee centralized payer enrollment and reporting processes for facilities and providers • Supervise enrollment and reporting staff, including hiring, training, performance reviews, workload assignment, and problem resolution • Develop productivity standards, tracking reports, processes, and workflows • Supervise completion, submission, tracking, and follow-up for facility and provider applications • Advise the Director of Professional Services and notify administrators or VPs about enrollment issues and process breakdowns • Research enrollment requirements and ensure documentation complies with policies, regulations, and accreditation standards • Maintain credential database integrity and coordinate with IT and the software vendor to resolve issues • Oversee preparation of HPN rosters, ASO reports, provider profiles/rosters, and staff meeting reports • Supervise monthly system-wide enrolled-provider reporting for compliance and revenue-cycle operations • Ensure payer reporting compliance for more than 20 delegated-credentialing payers • Develop and maintain service benchmarks and quality-improvement programs • Communicate with payers to resolve authorization and billing denials related to participation status • Collaborate with medical staff leaders, hospital administrators, office managers, billing managers, departments, personnel, and customers • Maintain confidentiality, professionalism, attendance, punctuality, and a collaborative work environment

🎯 Requirements

• High School Diploma or GED required • Five years in managed care, physician’s office practice, or credentialing office • Seven years of health care industry experience • Two years of supervisory experience preferred • Extensive knowledge of the Director of Professional Services’ administrative responsibility areas • Expertise in NCQA, TJC, CMS, and state regulations related to enrollment processes • Knowledge of URAC, NCQA, and TJC standards • Proficient computer skills and thorough knowledge of Windows, MS Office, Excel, and Outlook • Ability to create, update, and run reports in the ECHO credentialing database or similar applications • Analytical and problem-solving skills with excellent attention to detail • Ability to work extended hours as needed • Ability to function in a demanding, fast-paced environment • Excellent organizational and prioritization skills; ability to manage multiple projects simultaneously • Ability to organize, delegate, direct, and review others’ work; apply laws, rules, regulations, policies, and procedures; create action plans; and manage implementation through completion • Excellent communication skills for interacting with influential internal and external contacts • Ability to maintain confidentiality

🏖️ Benefits

• Full-time position • 40 scheduled weekly hours • Exempt status