Job Description

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

NoOversees enrollment processes by providing oversight of the enrollment activities, provider enrollment record maintenance, Third Party Payers, relationship, and reporting activities. Oversees and provides direction to enrollment staff ensuring all staff members are educated to adhere to all accreditation and service standards. Assesses the need to revise enrollment database management systems and processes to meet all applicable regulatory standards, audit processes and quality improvement activities and to ensure customer/provider satisfaction in enrollment and provider record maintenance. Maintain responsibility for regulatory and organizational compliance as it relates to enrollment.

Job Duties:

• Develops and maintains enrollment function strategy and provides leadership on its component.
• May supervise enrollment staff to include assigning work, assessing performance, scheduling.
• Acts as the primary enrollment compliance resource with respect to regulatory and accreditation agency programs.
• Assists in coordinating enrollment data for regulatory audits; oversees audits with regulatory bodies related to provider enrollment and primary source verification.
• Participates in on-sight meetings with external parties as a subject matter expert as it relates to provider enrollment.
• Participates in workgroups and provides education as applicable to ensure enrollment standards remain compliant.
• Develops and maintains organizational and provider enrollment criteria, which measures providers according to quality and regulatory metrics.
• Ensures a systematic set of criteria is evaluated and approved by stakeholders.
• Develops and maintains enrollment policies and procedures in which meet all regulatory agency requirements and due dates.
• Develops enrollment strategy and provides leadership during acquisitions and network expansions in support of network goals and initiatives; assists in oversight on execution.
• Acts as the primary enrollment data flow knowledge expert to assist with preparation of surveys, directories, websites, marketing proposals and other data requests.
• Develops and revises, as needed, all documents, forms and standard letters used in the enrollment process.
• Reviews and routinely audits completed credentials files to ensure accuracy and compliance with department standards, and the organization’s enrollment criteria.
• Processes initial enrollment and re-enrollment for providers and organizational providers as needed.

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:

Education:

High School Diploma or Equivalent (GED)- (Required)

Experience:

Minimum of 5 years-Related work experience (Required)

Certification(s) and License(s):

Skills:

Communication, Computer Literacy, HR Policies, Standards And Procedures, Office Politics And Confidentiality, Teamwork

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.