• Provider Network Enrollment Supervisor

    Job Locations US-NC-Hickory
    Posted Date 2 weeks ago(12/5/2018 5:57 PM)
    Job ID
    # of Openings
    Community and Social Services
  • Overview

    Excellent Benefits Package!!!

    Projected Hiring Range: 51,395 – $54,100


    Closing Date: 12/19/2018 by 4 PM


    Primary Purpose of Position:  This position assists in the enrollment, development and management of the provider network for consumers who have been identified as having mental health, substance abuse or intellectual development disability needs.



    Role and Responsibilities:


    • Provides direct supervision to enrollment staff including, recruiting, hiring, training and providing disciplinary action to individuals as needed;
    • Oversees enrollment of providers into the Partners Network according to parameters determined for qualifications and needs of the Network;
    • Assists in the full implementation of the credentialing database ensuring maximum efficiency and full utilization of functions;
    • Attention to detail and adherence to strict timelines is essential to the success of this position;
    • Must be able to work independently and use good judgement in making critical decisions that impact service availability inside the Partners network;
    • Obtains and maintains time sensitive confidential provider information;
    • Must have a good working knowledge of NC Tracks;
    • Tracks on enrollment activities and ensures timely and accurate data entry by enrollment staff;
    • Works directly with the Credentialing Supervisor to validate data between the enrollment and credentialing databases;
    • Communicates clearly and effectively with providers, external stakeholders and internal staff on a regular basis;
    • Serves as a liaison and a resource to other departments within the LME/MCO and with various NC DHHS Departments, per rule requirements, to coordinate enrollment activities;
    • Participates in Provider Forums as requested and provides technical support and assistance to Provider Councils as needed;
    • Participates in oversight and monitoring reviews of the MCO including but not limited to URAC, Mercer and EQR reviews as appropriate;
    • Develops and maintains policies and procedures related to enrollment.


    Knowledge, Skills and Abilities:

    • Considerable knowledge of the laws, regulations and policies that govern the program
    • Exceptional interpersonal and communication skills
    • Strong problem solving, negotiation, arbitration, and conflict resolution skills
    • Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint
    • Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
    • Ability to make prompt independent decisions based upon relevant facts
    • Ability to establish rapport and maintain effective working relationships
    • Ability to act with tact and diplomacy in all situations
    • Ability to maintain strict confidentiality in all areas of work




    Education/Experience Required:  Bachelor’s Degree and three (3) years of credentialing, enrollment, auditing, claims processing or monitoring experience in healthcare/managed care.  Two (2) years of administrative supervisory experience required. Must have ability to travel.


    Education/Experience Preferred:  Master's degree in Healthcare Management.  Certified Provider Credentialing Specialist (CPCS) and/or Registered Healthcare Information Technician (RHIT) preferred.




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