Job Description

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

YesProvides leadership assistance to the operations of assigned department(s). Responsible for Provider and Facility Enrollment Services.

Job Duties:

• Manages enrollment of providers and facility for the Health System as it applies to the Joint Commission, PA DOH, CMS, and third-party payer rules and other applicable regulatory standards to the enrollment processes within the system.
• Reviews and analyzes data necessary to complete enrollment filings, processes and roster development for payer agencies and organizations. Oversees the team’s assessment of completeness of information and providers' qualifications relative to established standards. Identifies potential issues and flags adverse information from application materials for the purpose of obtaining necessary information in preparation for filing submission. Works with Legal Services/Risk Management to assist in addressing enrollment related status updates, changes and revalidation processes.
• Responsible for addressing compliance preparation related to DOH, Joint Commission or federal visits for the facilities or suppliers of the Geisinger System. Confirm and supplies requested policy information related to payer compliance and processes, coordinates any oversight reviews, and responds to information requests from managed care organizations for GHS delegations for employed Geisinger Clinic physicians. Works with Third Party Contracting staff to ensure required information is gathered for delegated functions prior to implementation.
• Manages the provider and hospital enrollment duties for the Geisinger System, Medicare and Medicaid Enrollment, and Third-Party Payor contracted applications.
• Responsible for Management of Enrollment Work Queues and collaboration with Revenue Management Operations
• Works closely with Geisinger System Executive leadership, Service Line leadership, clinical directors, Legal Services, and third-party payors to develop strategic goals and processes for credentialing, and enrollment for the Health System.
• Provides insight into third-party payer enrollment process to assist with Geisinger development, operational and expansion strategies.
• Communicates the departmental activities to the System Director, Credentialing & Enrollments, AVP Administrative Service with indirect reporting relationship to the Chief Medical Officer /Chief Quality Office and Chairperson of the GHS Credentialing Committee as it relates to issues with enrollment processes.
• Performs special assignments and participates in special projects at the request of the Executive and Administrative leadership to address questions or troubleshoot enrollment related issues.
• Develops enrollment policies, processes and procedures which meet all regulatory agency requirements. Maintains and updates, as needed, all documents, standard letters or emails used in enrollment processes.
• Leads training and ongoing education for new and existing staff to ensure accurate, efficient enrollment processes aligned with Geisinger, payer, and regulatory requirements. Ensures the team receives timely updates and training related to changes in third‑party agency processes, manages service line education on system policies and procedures, and oversees staffing levels, scheduling, and staff engagement to meet productivity and quality standards.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details:

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Education:

Bachelor's Degree- (Required)

Experience:

Minimum of 5 years-Relevant experience* (Required), Minimum of 3 years-Managerial/Supervisory (Required)

Certification(s) and License(s):

Skills:

Acts Decisively, Financial Analysis, Flexibility, Leads Others, Organizing, Problem Solving, Professional Presentation

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.