The Director leads and directs the system-wide provider enrollment process for employed providers and independent Piedmont Clinic providers.
1. Directs a health system level service for enrollment of employed providers and independent Piedmont Clinic providers with both governmental and commercial payers for purposes of claims submission.
2. Provides direct leadership and management for provider enrollment team members.
3. Recruits, hires, and develops staff as needed to support an effective enrollment infrastructure.
4. Creates effective training programs, policies, and processes to ensure best practice adoption.
5. Develops the annual enrollment department budget and as necessary, strategic initiatives aligning with Piedmont’s overall strategic plan.
6. Creates and fosters a culture of customer service within the enrollment department to better serve all stakeholders.
7. Participates on acquisition / integration teams and oversees the enrollment related responsibilities of onboarding new individual providers and provider groups.
8. Develops actionable plans to scale enrollment services to maintain high customer service given changing workload demand.
9. Participates in the administration of the credentialing / enrollment software system.
10. Responsible for quality control of content and completeness of provider data within the credentialing / enrollment software system.
11. Collects, monitors, and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement.
12. Focuses on enrollment related continuous process improvement to ensure optimal operation.
13. Effectively collaborates with and serves as the primary point of contact for all Piedmont enrollment stakeholders including senior leaders, managed care, central billing office, independent providers / administration staff, central verification office, and hospital medical staff offices.
14. Establishes and maintains strong and mutually beneficial relationships with all participating health plans and serves as the primary point of contact for provider enrollment related topics with all applicable third party payer representatives.
15. Conducts regular communication with payers including quarterly distribution and reconciliation of provider rosters.
The above information is intended to describe the general nature and level of work being performed by people assigned to this job. It is not intended to be an exhaustive list of responsibilities, duties and skills required of personnel so classified.
MINIMUM EDUCATION REQUIRED:
A Bachelor’s Degree with a major in Healthcare Administration, Business Administration, or a closely related field.
MINIMUM EXPERIENCE REQUIRED:
Seven (7) years of progressive healthcare leadership experience including a minimum of (2) years of credentialing/provider enrollment experience in a hospital, multi-provider ambulatory practice, or third party payer setting.
A Master’s Degree in Healthcare Administration, Business Administration or a closely related field. Experience with enrollment / credentialing database software. Certification through NAMSS as Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional in to ensure optimal operation.
Internal Number: 121127
About Piedmont Clinic
At Piedmont Healthcare, we believe that prevention is the best medicine. That's why we are dedicated to providing the kind of care that helps our patients achieve and maintain better health. With over 230 primary care physicians that specialize in internal medicine, pediatrics and family medicine and 65 specialists you’re sure to get care for the whole family when you need it. We are available throughout Atlanta and surrounding communities and offer service that's both complete and convenient. In fact, there's likely an office in your neighborhood, where you can get expert care when you're sick or need routine check-ups and physicals — plus have access to Piedmont's network of hospitals, care centers and specialists.