Experience a rewarding and fulfilling career with Mercyhealth. Mercyhealth is committed to offering our partners a best place to work. Our unique workplace Culture of Excellence is built upon:
Employee engagement, empowerment and growth
Teamwork toward our common goal – providing exceptional health care services with a passion for making lives better
An atmosphere of caring and quality that cascades throughout the organization
Essential duties and Responsibilities
Oversees day-to-day operations of the provider enrollment team, providing direct support, organization, and completion of all initial and renewal provider enrollments with all government and commercial payors for all Mercyhealth providers who maintain billing privileges.
Supervises, trains, monitors, and audits performance of provider enrollment coordinators. Works with database support staff to ensure software updates are implemented.
Collaborates closely with Provider Recruitment, Medical Staff Office, Revenue Cycle, and Information Systems to ensure effective communication regarding new physicians.
Responsible for accurate and complete data entry of credentialing enrollment information into the credentialing/enrollment database; ensures provider enrollment and credentialing data is organized and handled in an efficient manner to minimize time needed to secure proper payor provider numbers.
Participates in provider enrollment application preparation, finalization, submissions, follow up and resolution; communicates with providers and operational leaders on status of applications.
Review and manage provider enrollment processes to ensure that policies/workflows (desktop manuals, policy updates, etc.) are in compliance with Mercyhealth, State, Federal, and NCQA guidelines, as well as contracted health plan directives.
Serves as organizational resource for government/third party payer credentialing regulation and in maintaining systems which are consistent with current industry standards. Maintains familiarity with healthcare AR revenue cycle management and what is required to attain optimal collection performance standards.
Actively engage in addressing special projects as they arise, conducting preliminary research, follow up, and tracking/monitoring to facilitate ongoing reporting of project status. Provides valid feedback to the Director on departmental issues and progress.
Assists director with budgeting and short- and long-term goal setting.
Other Skills and Abilities
Knowledge of credentialing guidelines by TJC (The Joint Commission), NCQA, CMS and CAQH; demonstrates working knowledge of healthcare and credentialing industry, including medico-legal issues and laws, regulatory agencies and other national standards; excellent professional telephone etiquette and communication skills.
Proactively prioritizes needs; shows attention to detail; communicates clearly and concisely; possesses excellent interpersonal & written communication skills including spelling, grammar and basic mathematical calculations.
Possesses effective presentation skills and works effectively in a team environment, showing respect for each person’s skills and knowledge. Establishes and maintains long-term customer relationships by building trust and respect; articulates knowledge and understanding of organizational policies, procedures, and systems; demonstrates proficiency in Microsoft Office (Word, Excel, Access) and other applications, as required; demonstrates knowledge of credentialing software; maintains confidentiality of privileged information; knowledge of accepted practices related to primary source verification; drafting of policies/procedures for submission to director for review and approval.
EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans.
Education and Experience
5 years of experience in a healthcare-related environment required, preferably with enrollment of providers with payors and provider network management.
Bachelor’s degree preferred.
Previous supervisory experience preferred.
Special Physical Demands
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
This position is considered sedentary work exerting up to 15 pounds of force occasionally. Manual dexterity to operate a keyboard, telephone, fax, scanner and other office equipment as necessary to perform duties. While performing the duties of this job, the employee is frequently required to sit; reach; use fingers to handle, finger and feel; and talk/hear. Employee will occasionally stand; walk; and stoop/kneel/crouch/crawl. Specific vision abilities required for this job include frequent close vision, distance vision, and ability to adjust focus with occasional color vision, peripheral vision and depth perception. Repetitive finger/wrist movement associated with the use of a keyboard.
Internal Number: 20135
Mercyhealth is a non-profit regional health care organization with more than 8,000 employee partners, 5 major hospitals, and 80 facilities and clinics throughout the Northern Illinois and Southern Wisconsin region. We are committed to being a top integrated health care provider and continuously work to make life better for the people, families and communities we serve.
Our partners serve with compassion, dedication, pride and professionalism. Our culture focuses on employee engagement, empowerment and growth, working together as a team to achieve one common goal: our mission of providing exceptional health care services, resulting in healing in the broadest sense and a best-in-class place to work for our partners.
We place great importance on providing our partners the tools, resources, facilities, and support to create lifelong career opportunities with an emphasis on a rewarding work-life balance. We achieve this by offering partners:
• Competitive compensation and benefits
• Tuition and certification reimbursement
• Generous PTO accruals
• Career ladder and advancement opportunities
• Partner recognition days and achievement awards
• Local/regional discounts and incen...tives
At Mercyhealth, we serve with a passion for making lives better, and we truly believe our accomplished staff is second to none in this mission. We hope you’ll consider becoming part of the Mercyhealth family.