This position will manage the day-to-day operations of the Provider Enrollment and Life Cycle teams at Priority Health. This involves providing leadership to a team of 12-24 individuals to assure that both goals and standards are being met, leading in project management and process improvement initiatives. Other essential functions of this role will include:
• Utilizes performance tracking and trending tools to allow for daily monitoring of inventory levels to ensure that departmental Service Level Agreements are met. Reviews the performance of assigned work per team member at regular intervals. Identifies successes and areas of improvement, implements appropriate counseling and performance improvement action plans according to HR regulations and guidelines.
• Participates in management of departmental budget and finances in a cost-effective manner by assisting leadership or designee with development of the budget, monitoring expenditures, ensuring purchases are appropriate, and adhering to financial processes, policies and guidelines.
• Serves as the subject matter expert on the end-to-end operational administration for provider systems set-up and configuration, credentialing and re-credentialing processes. Works closely with other supervisors and managers to assure proper alignment with long term team, department and corporate goals.
• Participates in process improvement planning; attends resourcing and planning meetings for projects. Effectively develops, prioritizes, and implements project plans as assigned by management. Communicates project progress in a clear and timely manner. Identifies, secures and coordinates the departmental resources. May initiate contact with outside vendors, as appropriate, if that may lead to cost effective solutions.
• Maintains and monitors the standards set forth by CMS, NCQA, HEDIS and other regulatory agencies in order to support provider reporting requirements. Manages audit requirements for SOC1, SSAE and MAR.
• Prepares forms and reports for internal and/or external auditing departments according to the schedule. Assists with the completion of NCQA audit requirements and HEDIS data collection tools for measures related to Credentialing, Practitioner Turnover and Compensation.
Education - Bachelor's Degree in healthcare, management, business administration, technical or related field required
Experience - 5 years of experience in healthcare, insurance, managed care and/or comparable industry required, along with 5 years of experience in management of people and processes within an operations area.
Education - Master's Degree in related discipline
Experience - Accreditation and/or regulatory bodies like NCQA, CMS, MDCH, TJC, etc, standards related to credentialing and/or billing, and/or quality auditing requirements. Experience with provider configuration, credentialing, claims and/or comparable systems. Experience in designing, running and/or analysis of reports utilizing Access databases, Business Objects Report Writer, and/or comparable reporting tools
Licenses - CPMSM and/or CPCS Certification
We are an Equal Opportunity Employer and do not discriminate against applicants due to race, ethnicity, gender, veteran status, or on the basis of disability or any other federal, state or local protected class.
Nearest Major Market: Grand Rapids
Priority Health - 5 months ago
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