The Director of Provider Enrollments will own the overall experience for clients and the success of the HPI provider enrollments process. This individual will oversee a team with varying levels of expertise in provider insurance and hospital application submission, application follow up, CAQH and research.
The ideal candidate exhibits in-depth knowledge of provider enrollments functions. They will work closely with other HPI leaders, with a heavy focus on building positive and productive relationships with our Sales, Client Success and RCM Operations teams while also understanding and supporting the relationship with our clients. Your expertise must result in a superior client management experience and a positive brand image, leveraging data to drive decisions.
Functioning as a true operational leader, you will guide a performance-driven team while also applying new ideas and maintaining a constant focus on an efficient, high-quality experience that exceeds the expectations of our customers. This individual will readily adopt and support the HPI values, with an emphasis on driving a culture of accountability and ensuring all teammates are living our values.
Essential Duties and Responsibilities:
• Directs, leads, and manages the provider enrollment department’s day to day operations, recruits, selects, orients, trains, coaches, counsels, and disciplines staff.
• Develops relationships with the provider enrollment teams and documents needs and organizational priorities.
• Ensures success of the provider enrollment lifecycle by monitoring client level metrics as well as ensuring timeliness and accuracy of team’s enrollment activities related to new enrollment, reenrollment, enrollment denials and client level special projects.
• Develops relationships with clients and provides regular status updates on credentialing related deliverables.
• Makes recommendations on work-flow processes throughout the enrollment cycle to assist in achieving consistency and success.
• Develops and makes recommendations on policies, guidelines, and implements procedures to ensure consistent department-wide implementation and adherence.
• Holds monthly (or as warranted) meetings with all levels of management to review held claims, status of client provider enrollment, overall provider enrollment inventory, etc.
• Monitors timeliness and effectiveness of department activities, implements processes to identify gaps.
• Compiles and prepares a variety of reports for management to analyze trends and make recommendations.
• Provide client level support of projects, serving as leadership sponsor on key opportunities orescalation point where needed.
• Lead and develop a high-performing team with accountability that emphasizes people and performance management, coaching and development, and employee engagement.
• Conduct performance monitoring, career path progress, regular one-on-ones, and yearly performance evaluation in support of development of all team members.
• Recommend and assist with organizational changes required to improve organizational effectiveness.
• Develop and implement long and short-term strategies that drive results and aligns with our overall corporate strategy and values.
• Performs special projects and other duties as assigned.
Required Skills/Attributes:
• Passion for working with clients and driving successful customer outcomes.
• Comfortable analyzing and making sense of large amounts of information to identify key considerations and develop appropriate plans and action as a result.
• Ability to create and maintain a work environment where others are motivated/inspired to act and deliver service excellence.
• Proven ability to manage client escalations to timely resolution resulting in increased client satisfaction and retention.
• Embraces technology/innovation and uses it to create efficiencies.
• Exceptional partner in collaboration with other leaders.
• Proven experience in implementing productivity improvement and process efficiencies.
• Demonstrated ability to correlate activities to key business outcomes.
• Ability to manage the day-to-day needs with focus and passion while also elevating to a high level view to guide growth and strategy where needed.
• Track record delivering feedback and motivation that creates a culture of accountability while maintaining energy & engagement in the team.
• Experience working in a fast-paced environment including organizational skills with the proven ability to handle multiple and competing priorities.
• Superb communication, collaboration, and problem-solving skills rooted in a client-centered approach.
• Sense of urgency necessary to meet goals and deadlines, with ability to be persistent and proactive.
Qualifications:
• Bachelor’s degree with master’s degree preferred.
• 6+ years’ experience managing and leading a team.
• 5-7 years of increasing responsibility with provider enrollments functions.
• 3+ years’ executive experience working with senior and C-suite executives.
• 2-3 years of Revenue Cycle Management experience (provider/payer enrollments, EDI, credentialing, contracting, compliance, scheduling, coding, billing, follow up, transactions, patient financial services).
• Medicaid/Medicare and CMS regulatory experience.
• Experience with CAQH database, NPI website and maintaining EDI, EFT, and ERA processes preferred.
• Healthcare, clinical workflows or financial services industry experience strongly preferred.
Travel Requirements:
• Ability to travel 25-50% for essential business needs only in accordance to public health, client, or potential client safety protocols and requirements where applicable, to reduce risks during and after travel which may include vaccinations, masks, social distancing, quarantines, and any client site/facility requirements regardless of personal preference (some clients may require an employee to be fully vaccinated and show proof of vaccination before being allowed on site).
Physical Requirements:
• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds.
Health Prime is an Equal Opportunity Employer