Encompass Healthcare Data Solutions is seeking a Credentialing / Payer Enrollment Supervisor to join our growing Credentialing & Payer Enrollment (C/PE) Team! Currently the C/PE team is supporting 29 clients in multiple states and a roster of 800 providers and lab locations in all 50 Sates. The Supervisor is responsible for assisting the Director with daily supervision and operations of the entire C/PE department. The Supervisor coordinates the delivery of credentialing and payer enrollment services (C/PE) for medical staff Clinicians in accordance with EHDS process, contractual, accreditation and regulatory standards, while serving as a subject matter expect (SME) on credentialing and payer enrollment services. This includes managing all aspects of credentialing, re-credentialing, enrollment and revalidation of applications and primary source verification process for all Clinicians (MD, DO, Advanced Practice Professionals) to meet standards and requirements of National Committee for Quality Assurance (NCQA), Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), federal and state, and other regulatory or accreditation bodies. The Supervisor also manages the database to ensure it is updated in real time, data is current, accurate and valid. They will also be responsible for developing and executing plans that contribute to the overall success of the department under supervision of the Director while managing a team of MSP coordinators.
Preferred candidates will possess the following knowledge and experience:
Subject matter expertise (SME) in all aspects of provider C/PE, including:
C/PE -related regulatory and compliance standards;
Council for Affordable Quality Healthcare (CAQH) ProView registry;
CMS Medicare enrollment, supplier types, CMS Program Integrity Manual, deemed Medicare status, CMS I & A Access Management System, PECOS, NPPES NPI Registry, CMS incentive programs and quality reporting;
Medicaid enrollment, supplier types, and portal management;
Commercial payer plans, products, enrollment, directory validations, and portal management;
Healthcare business corporate structure, ownership & managing control, organizational structure, and contract & enrollment implications of changes of ownership;
NPI (Taxonomy) code designations for facilities, groups and providers;
All elements of Primary Source Verification for hospital credentialing and mandatory requirements for commercial and non-commercial payers;
Medical staff credentialing requirements and committee approval processes;
Delineations of privileges, FPPE, OPPE, basic file addendums to credentialing process;
Coordination of credentialing with professional liability/malpractice coverage types;
Implications of adverse events, sanctions, revocations, peer review decisions etc
NAMSS CPCS or CPMSM certification (current or achieved within 24 months of hire).
At least four (4) years of progressive experience in C/PE environments (e.g. medical staff services, CVO, payer enrollment).
Experience with C/PE software systems (e.g. Echo).
Knowledge of healthcare revenue cycle management.
Bachelor’s degree in business, healthcare or related field.
Process improvement (e.g. Lean, Six Sigma) experience.
If you’re interested in a fast-paced, growth-oriented C/PE opportunity, we would love to talk with you! We offer a competitive compensation and benefits package, a progressive work culture, and great place to live, work and play in scenic Northern Colorado! Please follow this link to learn more about this opening and submit your application: CPE Supervisor Application.
Encompass is an equal employment opportunity (EEO) employer and will consider applicants without regard to race, color, religion, sex, national origin, disability, veteran status or any other protected class.
Internal Number: 149
About Encompass Healthcare Data Solutions
Encompass Healthcare Data Solutions is a full-service medical group practice management company based in Fort Collins, Colorado that serves practices nationwide. Our service lines include credentialing/payer enrollment, revenue cycle management, quality management, IT services, and HR support. We are proud to be a four-time recipient of the Bizwest Mercury 100 award, which recognizes Northern Colorado’s fastest-growing companies! Encompass provides a competitive compensation and benefits package, including paid time off, medical, dental, vision and life insurance, short term disability, retirement plan, and education assistance!
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Phone: 202-367-1196 | Fax: 202-367-2196 | E-mail: email@example.com