Team Lead, Provider Enrollment

Job Purpose

The information below covers the role requirements, expected candidate experience, and accompanying qualifications.

The Team Lead, Provider Enrollment is responsible for training and oversight of offshore team members and assisting the provider enrollment manager to ensure the credentialing / enrolling of new and established health care providers and other policies / procedures of the department are being followed.

Duties and Responsibilities

• Assist in the oversight of issue resolution for the provider education process regarding application completion and submission
• Assist in the oversight of ensuring that the collection, updating and maintenance of necessary provider information and documentation is completed
• Assist in ensuring the enrollment follow-up, by client and payer, is completed within departmental and client parameters
• Ensure that provider enrollment applications for all initial applications and re-credentialing are completed in a timely and complete manner
• Assist in the oversight to ensure that verification of provider and group information with insurance companies is completed
• Assist in the coordination of information for enrollment and termination of all providers and communicate to team and clients as appropriate
• Contributes to the departmental process and procedures with a collaborative approach
• Assist in the oversight of the monitoring of provider enrollment work queues and smart feeds and other provider reports to ensure they are kept current and communicate areas of opportunities and trends to the Manager
• Assist in the training and education on enrollment processes or required research for accuracy
• Organizes, schedules and conducts all training activities of the onshore and offshore provider enrollment team as it relates to enrollment follow-up
• Documents and records training sessions to be used for future reference
• Monitors and analyzes productivity along with performing Q / A for offshore team
• Provides timely feedback to offshore provider enrollment regarding Q / A process and results
• Identify struggles with offshore provider enrollment staff and provide guidance when needed
• Performs other duties as requested
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

Working Conditions

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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