Mgr Delegated Credentialing & Prov Enrollment WMCG
Wellstar Health Systems

Job Info

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Facility: 699 Broad Street

Job Summary:

This individual will serve as a resource for the WMCG provider delegated credentialing and enrollment team in Augusta and will make sure that all provider applications are completed accurately and submitted to all applicable government and commercial payors in a timely way by the WMCG provider enrollment team. The Manager will work with the WMCG medical staff services team, managed care payors, WMG and WMCG operations, the Wellstar managed care department, the revenue cycle team and credentialing staff to ensure that the provider enrollment process runs smoothly, timely and no enrollments are missed. Also, this individual will ensure that there is a timely, appropriate and accurate response from managed care payors to avoid delays in enrollment for WMCG.

Core Responsibilities and Essential Functions:

Monitors, prioritizes and audits workloads to ensure credentialing and enrollment tasks are completed timely and correctly.

Interviews, trains, counsels and evaluates staff. Makes sure that all new staff are appropriately trained and oriented.

Insures the team has all of the information, tools, knowledge and training necessary to complete applications, follow-up on requests and any post enrollment actions needed for all commercial and governmental payors.

Works with the enrollment team to monitor responses from managed care payors to enrollment requests and assists staff as needed with follow-up to avoid denied applications and delinquent responses.

Oversees provider enrollment function to insure that the delegated credentialing process, provider enrollment functions and all post-enrollment follow-ups are working as efficiently and as timely as possible.

Makes sure that staff updates credentialing software with new provider enrollment requests, changes and new information.

Assist Director and other staff in management of team payroll, staffing and workload.

Performs other duties as assigned

Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• High School Diploma General or Bachelors Business Administration/Management-Preferred

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 5 years Credentialing, billing, managed care, healthcare customer service. Required
Minimum 5 years Exceptionally strong skills in using internet browsers, websites and the Microsoft Office Suite of Products Required
Minimum 5 years Database management skills (data entry and editing) Required
Minimum 5 years Working knowledge of enrollment processes with various managed care payors. Required
Minimum 4 years Managing and/or supervising employees and staff in a manager or supervisor role. Required

Required Minimum Skills:

Self-directed, ability to work autonomously in a fast-paced environment and prioritize multiple assignments without direct supervision. High
Exceptionally strong organizational skills High
Exceptional detail organization High
Ability to prioritize projects and meet competing and demanding deadlines. High
Strong verbal and written communication skills High
Strong interpersonal skills, ability to interact comfortably with providers, managed care organizations, colleagues, senior leadership. Demonstrates effective communication skills to manager interpersonal relationships both internally and externally. High
Exceptional customer service skills; ability to understand and address core issues. High
Deep knowledge of credentialing to NCQA standards, managed care contract requirements and provider enrollment processes. High

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