AdventHealthProvider Enrollment/Quality Manager-Remote
Altamonte Springs, FL

AdventHealth

All the benefits and perks you need for you and your family:

· Benefits from Day One

· Career Development

· Whole Person Wellbeing Resources

· Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday-Friday

Job Location : Remote

The role you’ll contribute:

Under limited supervision, oversees the operations of the AdventHealth provider Multistate and Florida Commercial payor enrollment/credentialing functions to develop, manage and monitor processes and procedures that support the credentialing, re-credentialing, expirable data management and Payor enrollment. Responsible for managing the Multistate and Florida commercial Payor, provider enrollment, employee Multistate and Florida credentialing and ongoing monitoring/expirable teams. Functions include applications and credentialing services for various physician groups and specialties for which Multistate and Florida Commercial Payor and contracting services are provided. This position ensures all enrollment systems are current and accurate and all credentialing and contracting information is disseminated to the appropriate persons. Manages the auditing and data analysis for all Multistate and Florida physician and ancillary, Commercial enrollment and credentialing files, documents and ensures correctness/completeness of data. Responsible for supporting Network Management/MSOW, MD Staff and EPIC applications (or any other necessary application) to generate reports necessary to ensure accuracy of provider records. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you’ll bring to the team:

PRINCIPAL DUTIES AND JOB

RESPONSIBILITIES: SYSTEMS - 15%

· Responsible for supporting management and functionality of Network Management (or any subsequent credentialing database

COMMUNICATION - 10%

· Communicates with provider office staff and practice management regarding the status of applications, additional materials required, etc.

SUPPORT - 15%

· Supports Director of Credentialing/Operations, Government Credentialing Manager/Multistate and Manager of Revenue Management by resolving problems, questions, and issues while making sound decisions within the Managed Care enrollment team as well as for the Payors and the practices

LIAISON - 5%

· Serves as liaison to credentialing staff at both Payor organizations and provider office

INFORMATION - 15%

· Responsible for ensuring credentialing information is accurate and current in multiple venues such as hospital systems, local databases such as Network Management (or any subsequent credentialing database), files, and on-line databases such as CAQH and Multistate and Floria Commercial Payor enrollment systems; maintains standards in accordance with NCQA criteria.

DEVELOPMENT, EDUCATION & TRAINING - 5%

· Responsible for ensuring team is appropriately trained in all aspects of their job responsibilities.

DEADLINES, TIMELINESS & PEFORMANCE STANDARDS - 15%

· Completes assigned tasks in the appropriate time frame and holds direct reports. accountable for meeting deadlines and performance standards. Maintains an acceptable work pace.

Qualifications

The expertise and experiences you’ll need to succeed:

KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:

· Demonstrates skill and understanding of the PECOS system.

· Ability to make administrative/procedural decisions and judgments. •Ability to investigate and analyze information and draw conclusions.

· Ability to develop and deliver presentations.

· Ability to process computer data and to format and generate reports.

· Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.

· Ability to communicate effectively, both orally and in writing.

· Ability to foster a cooperative work environment.

· Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.

· Skill in developing policy and procedure documentation.

· Database management skills.

· Employee development and performance management skills. Knowledge of related accreditation and certification requirements.

· Knowledge of medical credentialing and privileging procedures and standards.

· Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.

KNOWLEDGE AND EXPERIENCE PREFERRED:

· MSOW/Network Management

· EPIC

· MD Staff

· Proficient in MS Office (Excel, Word, Outlook)

EDUCATION AND EXPERIENCE REQUIRED:

· Bachelor's degree

· Five years of healthcare experience, preferably in managed care, provider credentialing, patient financial services, or provider relations

· 5 years healthcare managerial experience

EDUCATION AND EXPERIENCE PREFERRED:

· 10 years healthcare managerial experience.

· LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED

· within one year of hire:

· NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification and secure within 1 year of hire.

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

· EPIC

· Certified with Morrisey/MSOW/Apogee

· MD Staff

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Job Snapshot

  • Facility: AdventHealth Corporate

  • Job Schedule: Full-time

    Pay Range: $38.004 - $57.006

  • Location: Altamonte Springs, FL

  • Job ID: 24017849

  • Job Family: Managed Care

  • Shift: 1 - Day

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