SUMMARY

In addition to performing in the role of a Provider Enrollment Associate, provides leadership and assists the Director in facilitating the workflow, for a team of Provider Enrollment Associates.  Provides knowledge, expertise and guidance to the team, thus ensuring credentialing is completed in an organized and timely fashion.  Credentialing includes but is not limited to all carrier forms and online credentialing application processes and maintenance and training of Provider Enrollment Associates for Apogee software.  
Position requires thorough application review and filing with appropriate follow-up to ensure prompt payment by payors.

STATUS: Full-time

LOCATION: Riedman Campus

DEPARTMENT: Enrollment/ Quality

SCHEDULE: 40 hrs/week

ATTRIBUTES

• •    Basic computer skills required.
  •    Excellent customer service and communication skills required.

  Minimum Qualifications:
  •    Associates degree or an equivalent combination of education and work experience. 
  •    4 years related work experience in a healthcare setting preferred.

  Required Licensure/Certification Skills:

  •    Effective 4/1/21: NYS Notary Public required within one year (Per Diem employees excluded).
  •        Notary Public required 1 year from date of hire (Per Diem employees excluded).

  Rochester General Health System is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran

RESPONSIBILITIES

• •    Plans, organizes, assigns ans supervises the day-to-day operations and facilitates the workflow of the team.  Orients, trains, coaches, and evaluates team members to ensure a competent and productive workforce.
  •    Schedules and maintains adequate staffing coverage to ensure operational demands are met.
  •    In addition to performing in the role of a Provider Credentialing Associate, provides leadership and assists manager/director in facilitating the workflow for a team of Provider Credentialing Associates.
  •    Coordinates/communicates with director regarding team member’s performance thus providing feedback necessary for recognition and/or performance management/coaching.
  •    Develops new electronic processes in coordination with manager/director to increase efficiency of team.
  •    Monitors Apogee software setup for credentialing process, implementing changes as required to improve process efficiency.
  •    In accordance with departmental policies, provides knowledge, expertise and guidance to a team of Provider Credentialing Associates to ensure tasks are completed timely and accurately while meeting regulatory standards.
  •    Provide accurate and timely enrollment services in a prompt, professional, efficient and courteous manner, displaying STARS behavior to RGHS employed providers and team members.
  •    Offers efficiency and solutions to ensuring the accuracy of provider data and verification while maintaining files in payor enrollment software.
  •    Review and validate professional qualifications of providers to guarantee completion of provider applications.  
  •    Collect and submit all applications timely and supporting documentation needed for submission to contracted insurance payors.
  •    Complete and review provider applications for submission, protecting the confidentiality of private information contained within the applications, according to department policy.
  •    Prepare and maintain reports and summaries of enrollment activities for managers.
  •    Act as main point of contact for Claims Clearinghouse vendor; including Medicaid enrollment tracking process.
  •    Monitor communications with administration, practice managers, provider recruitment and the hospital credentialing department. 
  •    Monitor team workload.

EDUCATION:

LICENSES / CERTIFICATIONS: 

PHYSICAL REQUIREMENTS:

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.