Key member of the leadership team responsible for leading the regional enrollment team in all provider enrollment efforts, ensuring adherence to provider enrollment policy and processes with emphasis on reducing cycle time and revenue risk in support of department and organizational goals. Manage a staff of 41 including 2 managers and 2 team leads supporting Emergency Medicine and Hospitalists healthcare professionals in 25 states across the nation. Report to the National Provider Enrollment Director.✔Integral part of a successful Revenue Cycle Operation and the organization’s ability to meet financial goals, impact patient satisfaction, and client retention. ✔Supervise and hire new employees for the Provider Enrollment Department and conduct clinician onboarding.✔Research government and commercial carriers, such as Medicare, Medicaid, Tricare, and Blue Shield enrollment guidelines. ✔Resolve complex enrollment issues with government carriers for group and individual providers.✔Conduct provider orientation for newly hired physicians and mid-level providers, educating them on new government regulations and credentialing processes.✔Maintain database for provider numbers, CAQH, online enrollment applications, and NPI.* continued below *

* continued from above*✔Review A/R reports to minimize dollars on hold for provider numbers for 250+ hospital contracts with large hospital systems.✔Prioritize projects and manage new facility contracts for credentialing, revalidation, and recredentialing.✔Serve as a liaison for reimbursement, claims, EDI, ERA, and EFT with multiple Billing Centers. Assist with setting up multiple corporations for EDI, ERA, and EFT with carriers.✔Facilitate resolutions on claim denials that resulted in a provider or group denied or suspended (dis-enrolled) enrollment or payer errors. ✔Assist with M&A integrations, as well as start-up operations of new business to ensure a smooth integration with limited cash flow interruption. ✔Assist with special projects to enhance collections (change management), such as strategically reviewing processes within the organizational to tighten up our internal timeline to increase revenue cycle and minimize revenue loss associated to administrative errors, timely filing, and appeals.

Promoted to manage a team of 16 provider enrollment representatives responsible for coordinating all necessary provider enrollment applications for billing to various carriers. ✔Continuously evaluated and strategized to reduce or maintain optimal low balances in Provider Enrollment A/R.✔Initiated and completed escalations to remove obstacles in enrollment activities and reduce/prevent revenue risk.✔Approved write offs as appropriate once all avenues of revenue recovery were exhausted.✔Ensured start up related activities were managed effectively.✔Managed personnel, reviewed/approved time cards, and provided coaching, guidance, and career development.✔Collaborated with peers and business partners to achieve standardization in provider enrollment processes and those processes affecting provider enrollment from upstream/downstream partners.

Responsible for coordinating all necessary provider enrollment applications for billing to various carriers. ✔Ensured all applicable documents were sent/received in a timely manner to the authorized signer and prepared/submitted completed payer applications. Resolved application deficiencies as needed.✔Completed all CAQHs and CAQH re-attestations, online applications and re-enrollment applications.✔Worked with clinicians to assist in the onboarding process. ✔Obtained provider numbers for groups, physicians, and mid-level providers.✔Set up EFT, ERA, and EDI for new groups. Assisted with obtaining Submitter ID # for electronic data interchange.✔Served as a liaison with the Account Receivable Department regarding denied claims and when necessary refiled claims.✔Completed W-9 requests and insurance correspondence requesting information on providers for claims to be processed.✔Reviewed weekly exception reports from management to prioritize critical issues.

Reviewed eligibility of benefits, posted payments, researched claim denials, and researched canceled checks.✔Consistently met/exceeded demands, expectations and deadlines through exceptional work ethic and commitment to excellence.✔Served as liaison with other areas of the organization to provide a seamless service experience.✔Quickly and effectively resolved customer challenges and implemented complete problem resolution.