JOB PURPOSE: Leads and directs the system-wide provider enrollment process for employed providers and independent Piedmont Clinic providers.
1. Directs a health system level service for enrollment of employed providers and independent Piedmont Clinic providers with both governmental and commercial payers for purposes of claims submission.
2. Provides direct leadership and management for provider enrollment team members.
3. Recruits, hires, and develops staff as needed to support an effective enrollment infrastructure.
4. Creates effective training programs, policies, and processes to ensure best practice adoption.
5. Develops the annual enrollment department budget and as necessary, strategic initiatives aligning with Piedmonts overall strategic plan.
6. Creates and fosters a culture of customer service within the enrollment department to better serve all stakeholders.
7. Participates on acquisition / integration teams and oversees the enrollment related responsibilities of onboarding new individual providers and provider groups.
8. Develops actionable plans to scale enrollment services to maintain high customer service given changing workload demand.
9. Participates in the administration of the credentialing / enrollment software system.
10. Responsible for quality control of content and completeness of provider data within the credentialing / enrollment software system.
11. Collects, monitors, and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement.
12. Focuses on enrollment related continuous process improvement to ensure optimal operation.
13. Effectively collaborates with and serves as the primary point of contact for all Piedmont enrollment stakeholders including senior leaders, managed care, central billing office, independent providers / administration staff, central verification office, and hospital medical staff offices.
14. Establishes and maintains strong and mutually beneficial relationships with all participating health plans and serves as the primary point of contact for provider enrollment related topics with all applicable third party payer representatives.
15. Conducts regular communication with payers including quarterly distribution and reconciliation of provider rosters.
MINIMUM EDUCATION REQUIRED: A Bachelors Degree with a major in Healthcare Administration, Business Administration, or a closely related field.
MINIMUM EXPERIENCE REQUIRED: Seven (7) years of progressive healthcare leadership experience including a minimum of (2) years of credentialing/provider enrollment experience in a hospital, multi-provider ambulatory practice, or third party payer setting.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: None.
PREFERRED QUALIFICATIONS: A Masters Degree in Healthcare Administration, Business Administration or a closely related field. Experience with enrollment / credentialing database software. Certification through NAMSS as Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional in Medical Services Management (CPMSM).
Employer will assist with relocation costs.
Internal Number: 2001447
About Piedmont Healthcare Corporate
At Piedmont, we deliver healthcare marked by compassion and sustainable excellence in a progressive environment, guided by physicians, delivered by exceptional professionals and inspired by the communities we serve. Piedmont is a not-for-profit, community health system comprised of 11 hospitals, 3,000 physicians and nearly 22,000 employees.
Since the beginning, Piedmont has been a pioneer in patient care, fulfilling the health care needs of Atlanta residents and the surrounding communities. Today - more than 110 years since it was founded - Piedmont is known as a leading hospital system in cancer care, treatment of heart disease and organ transplantation. For more information, visit piedmont.org.
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