Supv, Prov Enroll-Life Cycle at Corewell Health in Grand Rapids, MI

Supv, Prov Enroll-Life Cycle Location: Grand Rapids, MI Job Summary Supervises the daily aspects of Provider Operations area, that can include, provider resolution, provider administrative appeals, provider enrollment, provider reimbursement, provider credentialing, and project management of multi-million dollar portfolio assigned and accountable to achieve strategic and operational goals. Ensure adherence and communicates departmental strategic goals, quality & training initiatives, and acts as a liaison for system support issues, to ensure operational efficiencies and continuity of care with providers and members. Essential Functions Supervises the operational efficiencies for the entire network of 82,000+ providers, provider groups, and facilities to resolve complex provider issue (inquiry) resolution, provider reimbursement issues, drives large provider group Operational Committee meetings to identify and establish root cause problem resolution. Supervises team members to achieve business goals that include maintaining productivity standards and quality standards. Develop, implement and maintain performance tracking and trending tools to allow for monitoring of overall team. Acts as project leader on the most complex special projects utilizing project management and technical computer skills to ensure all project activities is completed in an accurate timely manner. Serves as the subject matter expert on the end-to-end operational administration for systems set-up, configuration, and issue resolution. Supervises the organizational operational efficiencies for the entire network of 82,000+ providers, provider groups, and facilities to ensure precise provider demographic information that persist throughout Priority Health eco system, to ensure correct pay out of the yearly $40M Physician Incentive Program settlement to providers and billion dollar claims payout to providers, establishes and monitors correct primary care provider to member alignment, along with the compliance area ensures the accuracy of Find A Doctor, and ensures IRS compliance with provider financial reporting, i.e. W9. Supervisors and implements organizational operational efficiencies of our national provider networks. Acts as designate liaison by developing and maintaining purposeful long-term relationship with nation network account representatives, manages claims repricing payment system and repricing claims activities including overall review of claims, manages and ensure annual payment of multi-million dollar access fees are paid accurately and timely to all national networks. Monitors as well as develops policies, procedures, and effective controls to ensure that we are compliant with SAS70 and MAR in accordance with all corporate standards. Supervisory Responsibilities: Interviews, hires and establishes performance development plans; conducts staff performance discussions. Provides support, guidance, leadership and motivation to promote maximum performance. Qualifications Preferred Bachelor's Degree or equivalent with emphasis in health care, business management 3 years of relevant experience healthcare, insurance, managed care and/or comparable industry Required 3 years of relevant experience supervision of people and processes within an operations area Preferred 7 years of relevant experience in Microsoft applications including Word, PowerPoint, Excel and Business Objects Preferred 5 years of relevant experience Accreditation and/or regulatory bodies like NCQA, CMS, MDCH, TJC, etc., standards related to credentialing and/or billing, and/or quality auditing requirements. Preferred 3 years of relevant experience Experience with provider configuration, credentialing, claims and/or comparable systems Preferred CRT-Provider Credentialing Specialist, Certified (CPCS) - NAMSS National Association Medical Staff Services preferred Or CRT-Professional Medical Services Management, Certified (CPMSM) - UNKNOWN Unknown preferred Physical Demands Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs Waist to Waist > 5 lbs: Seldom up to 10 lbs Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs Waist to Overhead > 5 lbs: Seldom up to 5 lbs Bilateral Carry > 5 lbs: Seldom up to 10 lbs Unilateral Carry > 5 lbs: Seldom up to 5 lbs Pushing Force > 5 lbs: Seldom up to 25 lbs Pulling Force > 5 lbs: Seldom up to 15 lbs Sitting: Frequently Standing: Occasionally Walking: Occasionally Forward Bend - Standing: Seldom Forward Bend - Sitting: Seldom Trunk Rotation - Standing: Seldom Trunk Rotation - Sitting: Seldom Squat: Seldom Supine Lying: Seldom Stair Climbing: Seldom Crawling / Kneeling: Seldom Driving: Seldom Reach - Above Shoulder: Seldom Reach - at Shoulder or Below: Seldom Handling: Occasionally Forceful Grip > 5 lbs: Seldom Forceful Pinch > 2 lbs: Seldom Finger/Hand Dexterity: Frequently Visual Acuity ¹ [None = No; Seldom = Yes]: Seldom How Corewell Health cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance, pet insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids Department Name Credentialing and Enrollment - PH Managed Benefits Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 40 Days Worked M-F Weekend Frequency N/A CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling 616.486.7447.