Supervisor Credentialing and Enrollment

Overview

JOB SUMMARY:       The Supervisor Credentialing Enrollment is responsible for the timely, accurate, and compliant enrollment of Atrium Health providers with government payers, as well as the timely and accurate processing, follow up, and verification of completion of applications for participation in Medicare (NC/SC), NC Medicaid (NCTracks), SC Medicaid programs for AH providers and physician groups.  The position is responsible for ensuring that the credentialing and enrollment functions are completed in compliance with all Atrium Health, CMS, State and national accrediting agency(s) standards. 

ESSENTIAL FUNCTIONS:

• Independently processes and submits complete, timely and accurate enrollment applications to The Center for Medicare Services (CMS) and state Medicaid offices on behalf of new groups and currently employed Atrium Health Medical Group (AHMG) providers and groups billing under AH MG tax ID numbers.
• Resolves issues and supports Practice Leadership / Practice Manager regarding provider enrollment and credentialing for AHMG, Affiliates and the Professional Billing Office.
• Regularly follows up of status of submitted applications and provider maintenance requests with CMS and state Medicaid offices and communicates status updates to all constituents via MOAD or other tracking system and email.
• Demonstrates the ability to communicate professionally and clearly in both verbal and written form to physicians, corporate staff, external agencies, and government / managed care organizations.
• Accurately and clearly documents process steps, dates, and work status in the MOAD system. 
• Answers departmental telephone and emails, routes to appropriate staff and takes accurate messages as needed. Commits to return all phone and email inquiries within 24 hours even if not resolved.
• Manages time, prioritizes assignments and coordinates functions effectively to meet the departmental goals and quality standards.
• Maintains confidentiality of all information related to credentialing and recredentialing.
• Promotes and assists in the smooth, efficient delivery of departmental services to providers, AH MG, AH, and other corporate departments and outside agencies.

• Performs other duties and responsibilities as assigned with minimal supervision and within timeframe specified.
• Participates in performance improvement activities.
• Collaborates effectively with all personnel within the department and throughout Atrium Health.

Physical Requirements

Performs most duties under normal office conditions. Work may require sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles 20-50 pounds. Work is subject to time sensitivity, heavy volumes, and frequent interruptions, either by phone, email or other employees. Work requires frequent verbal and written communication to employees, corporate staff, providers, government or managed care organizations, and external agencies in English. Work requires occasional travel to other corporate offices. Use of personal vehicle required. Intact sense of sight and hearing required.

EDUCATION, TRAINING, EXPERIENCE

College bachelor’s degree required.  3+ years’ experience in a role that performs or supports provider enrollment or similar operations in a hospital or managed care environment is required.  Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred.  Experience with primary source verifications, Medicare, North & South Carolina Medicaid, NCQA and DOI standards is preferred.