Supervisor, Payer Enrollment & Reporting
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Job Description
Supervisor overseeing payer enrollment, credentialing, and delegated reporting for West Virginia’s largest health system. Managing staff, provider data, regulatory compliance, and payer operations.
Responsibilities:
- Oversee centralized payer enrollment and reporting processes for facilities and providers
- Supervise enrollment and reporting staff, including hiring, training, performance reviews, workload assignment, and problem resolution
- Develop productivity standards, tracking reports, processes, and workflows
- Supervise completion, submission, tracking, and follow-up for facility and provider applications
- Advise the Director of Professional Services and notify administrators or VPs about enrollment issues and process breakdowns
- Research enrollment requirements and ensure documentation complies with policies, regulations, and accreditation standards
- Maintain credential database integrity and coordinate with IT and the software vendor to resolve issues
- Oversee preparation of HPN rosters, ASO reports, provider profiles/rosters, and staff meeting reports
- Supervise monthly system-wide enrolled-provider reporting for compliance and revenue-cycle operations
- Ensure payer reporting compliance for more than 20 delegated-credentialing payers
- Develop and maintain service benchmarks and quality-improvement programs
- Communicate with payers to resolve authorization and billing denials related to participation status
- Collaborate with medical staff leaders, hospital administrators, office managers, billing managers, departments, personnel, and customers
- Maintain confidentiality, professionalism, attendance, punctuality, and a collaborative work environment
Requirements:
- High School Diploma or GED required
- Five years in managed care, physician’s office practice, or credentialing office
- Seven years of health care industry experience
- Two years of supervisory experience preferred
- Extensive knowledge of the Director of Professional Services’ administrative responsibility areas
- Expertise in NCQA, TJC, CMS, and state regulations related to enrollment processes
- Knowledge of URAC, NCQA, and TJC standards
- Proficient computer skills and thorough knowledge of Windows, MS Office, Excel, and Outlook
- Ability to create, update, and run reports in the ECHO credentialing database or similar applications
- Analytical and problem-solving skills with excellent attention to detail
- Ability to work extended hours as needed
- Ability to function in a demanding, fast-paced environment
- Excellent organizational and prioritization skills; ability to manage multiple projects simultaneously
- Ability to organize, delegate, direct, and review others’ work; apply laws, rules, regulations, policies, and procedures; create action plans; and manage implementation through completion
- Excellent communication skills for interacting with influential internal and external contacts
- Ability to maintain confidentiality
Benefits:
- Full-time position
- 40 scheduled weekly hours
- Exempt status
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