Facility:Work From Home - OhioDepartment:Payer Enrollment ManagementSchedule:Full timeHours:40Job Details:The Payer Enrollment Team Lead provides oversite of the Payer Enrollment staff. Position is responsible for preparing and submitting enrollment applications and supporting documents for hospital facilities, group submissions for physicians, professionals, and practices with payers. The Payer Enrollment Team Lead follows up on the status of applications, updates system information, and works with the revenue cycle and department staff.

　　Department Specific Job Details:

　　Acts as Team Lead related to Payer Enrollment, Epic WQ management and communication.

　　Team lead will be responsible for communicating all issues that impact credentialing to the entire team.

　　Remain current with all payers contracting requirements for payer enrollment and delegated credentialing activities.

　　Understand the timely filing requirements to ensure payer enrollment activities are completed in a timely manner to ensure payment of services.

　　Ongoing mentoring to payer enrollment staff. Provide education to staff as warranted.

　　Works closely with management across DCH and its affiliates to facilitate seamless coordination and payer enrollment process of all providers within organization.

　　Helps Manager direct the workflow regarding payer enrollment for all new, existing providers and services within hospital and its subsidiaries to ensure the accuracy of payer/provider data.

　　Creating providers within credentialing software to prepare provider for assignment to payer enrollment specialist.

　　Collaborate with other departments in a timely manner to resolve any PB/HB billing issues that are provider participation issues.

　　Delegated Official for PECOS, MITS for hospital and its subsidiaries as well as signatory for Payer applications

　　Hospital/Facility Enrollment

　　Compiles and maintains current and accurate information required by payers for hospital and its subsidiaries for payer enrollment

　　Completes hospital and professional group enrollment and re-validation applications, monitors applications and follows up as needed –

　　Assists Manager with enrollment applications for new payers, and updating of information for hospital or its subsidiaries as needed.

　　Completes Out of State Medicaid Applications as needed for hospital or its subsidiaries

　　Payer Enrollment – GroupCompiles and maintains current and accurate data for all group provider payer related activities related to payer enrollment

　　Completes enrollment and re-validation applications for Managed Care, Commercial and Government Insurance Carriers contracted by hospital or is subsidiaries; monitors applications and follows up as needed for facility and subsidiaries

　　Works with employed/contracted professionals as necessary to maintain current and accurate information on their behalf within NPPES, CAQH, and Physician credentialing files.

　　Ensures availability of provider information, current state licenses, driver’s license, DEA Certificates, malpractice coverage, board certification and any other required credentialing documents for all providers.

　　Tracks licensure for expirations to ensure all provider information maintained is up-to-date- accurate.

　　Ensures group provider practice addresses are current with health plans, agencies and other entities. Requires team approach with hospital and ambulatory administration personnel to ensure accurate information for provider profiles of location, specialty and service areas are correct.

　　Works with department to audit health plan directories for current and accurate provider information

　　Reviews provider information when received, to ensure accuracy of information and to identify clarifications, corrections to information required with insurance company

　　Participates in performance improvement activities on all aspects of the insurance enrollment and payer enrollment processes

　　Identifies needed resources/references/supplies and provides recommendations to the director.

　　Monitors the maintenance of a current practitioner database, ensuring appropriate notification to relevant departments when changes occur.

　　Works with revenue cycle team members to utilize aged receivables reports to perform audits on third party payers to identify and correct credentialing and insurance enrollment gaps and review payer mix.

　　Maintains a working knowledge of applicable Federal, State, and Local laws and regulations, including the Standards of Conduct, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behaviors.

　　Actively participates as a member of the onboarding team, payer enrollment team and others as requested by Manager.

　　Adheres to the confidentiality and HIPAA policies.

　　Implementation of CACTUS software – payer enrollment specialist role will involve critical assessment of provider data capture within software from initial set up and then continuance of record maintenance of provider data set as new providers are added, changes to specialties, practice locations, professional liability updates etc

　　Payer Enrollment – Access ManagementMaintains SharePoint - spreadsheet to identify users for each site, and associated access.

　　Performing add, change, and delete based upon user’s role within Dayton Children’s and employment status. Perform periodic audits of users and needs for access

　　Communications Greets guests and calls utilizing appropriate etiquette skills and courtesy

　　Expresses ideas clearly, concisely, directly and willingly both when speaking and writing

　　Communicates respectfully, courteously and in a timely manner

　　Responds to e-mails and voice mail messages in a timely manner – generally within 48 business hours.

　　Proofreads all written communications to ensure accuracy and completeness

　　Actively listens and practices 3-way communication and uses clarifying questions to ensure accuracy of message

　　Perform Quality AuditsWork directly with Manager to identify and establish training protocols.

　　Perform quality audits to identify possible training opportunities.

　　Develop monthly reports for each payer enrollment specialist containing monthly audit results.

　　Report findings of audits to Manager monthly

　　Performs other duties as assigned.

　　Years of Experience

　　Required – High School Diploma/GED

　　Preferred – Associates Degree

　　Healthcare Experience

　　Required – 2-3 years Healthcare billing/ revenue cycle, payer enrollment or provider credentialing

　　Preferred – 3 years of payer enrollment and experience with delegated credentialing

　　Other skills/Competencies required (communication skills, computer skills, customer service skills, etc.)

　　Required – Ability to learn new systems, Computer Skills-Word, Excel, Excellent communication skills, Critical Thinking skills

　　Preferred – Advanced computer skills, working with EPIC, Cactus, CAQH

　　Education Requirements:

　　High School (Required)

　　Certification/License Requirements:

　　At Dayton Children's we believe that each moment counts with our patients, families and with each other.

　　We are moving at a fast pace and are looking for the right talent for our team at Dayton Children's. We want people who embody our values and want to become a part of the Dayton Children's difference. If this is you, apply today!

　　Our values:

　　Safety--We make safety our first priority.

　　Compassion--We deliver compassionate, family-centered care to all we serve.

　　Ownership--We are the pediatric care experts and act knowing that every patient, visitor and the hospital is our collective responsibility.

　　Collaboration--We work collaboratively to care for children, their families and each other.

　　Innovation--We continuously innovate to make Dayton Children's even better today and into the future.

　　Equity -- We strive for an environment in which all feel welcomed, valued and fairly treated in order to reach their full potential.

　　Dayton Children’s is proud to be an Equal Opportunity Employer who values diversity and will not discriminate against minorities, women, protected veterans, individuals with disabilities, or on the basis of age, color, gender identity, national origin, race, religion, sex, sexual orientation or transgender status.