Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.
Job Summary
The Supervisor, Provider Enrollment is responsible for assisting with the day-to-day activities of the Provider Enrollment Department, act as the first line leader to staff, and contributes to the development of processes and procedures. Monitor the quantity and accuracy of activities performed by subordinate staff. Development of work plans, develop and maintain performance standards associated with various functions. Expert knowledge and independent application of state and federal regulations governing healthcare. A high degree of applied knowledge of provider enrollment nuances. Staff training and assisting staff to resolve complex provider enrollment issues. Perform deep-dive audits of specific accounts, payers, or the work performed by an individual. Draft processes and procedures consistent with applicable regulations and/or specific payers. Interpretation of complex regulations and department procedural billing policies; and supervisor of subordinate staff.
Essential Functions And Tasks
Supervise, train, and support provider enrollment staff responsible for licensing, provider enrollment, privileging, enrollment, reappointments and/or maintenance of professional credentials.
Work with Provider Enrollment Manager to complete employee relation duties as necessary such as coaching, mentoring, corrective action, or similar.
Review, edit, and process employee timecards, and schedules.
Assist with or prepare annual performance reviews for provider enrollment staff.
Send Medicare Revalidation reminders for all providers.
Monitor held claims in AIMs/Work release emails for held claims.
Conduct client calls to provide status updates on clients.
Work with AR to research provider enrollment related denials.
Work with Clean Claims to research provider enrollment related rejections.
Ensure any questions regarding releases are answered in a timely fashion.
Responsible for ensuring Medicare provider enrollment items are completed timely.
Work with Client Management to provide support on client concerns and updates.
Enrollment for special projects and provide additional support as needed.
Meet staff for one-on-one touch base on performance/feedback concerns.
Work with Payments for requested EFT enrollments/updates.
Develop, maintain, and track various performance measures.
Prepare status reports and perform special projects as required.
Performs other related job duties as assigned.
Education And Experience Requirements
High school diploma or equivalent required, college degree preferred.
Two (2) years experience in supervision.
Two (2) years experience in Provider Enrollment.
Knowledge of NCQA standards as it relates to provider enrollment and health plan enrollment.
Knowledge, Skills, And Abilities
Excellent verbal and written communication skills.
Proficient in Microsoft Office Suite and proprietary database applications.
Ability to use independent judgment and to manage and impart confidential information.
Ability to multi-task, manage priorities and meet critical deadlines.
Ability to work independently and in a fast-paced environment.
High level of awareness of pertinent details; excellent organizational skills.
