Provider Enrollment Manager Baton Rouge, LA

Verisys – Baton Rouge, LA

Provider Enrollment Manager Baton Rouge, LA

The Provider Enrollment Manager will supervise all aspects of the Verisys healthcare provider enrollment and state-specific licensing enrollment. You will also be responsible for providing oversight, daily administrative management, and direct supervision of credentialing and enrollment processes. Responsibilities will include ensuring 100% compliance with all Medicaid enrollment and participation regulations and guidelines.

You will design, modify and/or propose operational systems and processes to effectively and efficiently manage and coordinate the activities outlined within the departmental policies/procedures, Credentialing, and Certification programs and Work Plans. This position regularly interacts with leadership at all levels within the organization and works closely with Credentialing team members and leadership along with Production, Project Management, and external enrollment organizations. This role will ensure consistent execution of performance improvement programs and initiatives in addition to maintaining compliance with all contractual obligations, state regulations and NCQA standards for activities related to the areas of responsibility.

The Provider Enrollment Manager will oversee Credentialing Program Performance Improvement Initiatives/Programs Complaints and compliance audit and reporting of credentialing and enrollment practices.

This is a full-time salaried position located in Baton Rouge, LA with great benefits. We are a fun jeans and t-shirt environment, and supportive management. If you know your stuff and are looking for a cool environment and a challenging job with a creative outlet, then join our team!


Primary Tasks and Responsibilities

A day in the life:

  • Ensuring individual and team member adherence to all Verisys and state Medicaid Management Information System (MMIS) policies and procedures.
  • Serve as primary point of contact and subject matter expert for provider enrollment inquiries and representatives to share information, record and prioritize issues, and ensure issues are escalated, resolved, and evaluated for continuous improvement.
  • Develop and maintain professional, collaborative relationships with providers, payers, et al
  • Support continuous improvement and automation of provider enrollment processes by collaborating with various stakeholders to develop new or enhance existing techniques, policies and procedures.
  • Lead team huddles and participate in cross-functional meetings.
  • Serve as back up to any/all functional areas within Provider Enrollment.
  • What were looking for:

  • Working senior knowledge of Provider Enrollment procedures, policies, and Credentialing
  • Credentialing and Enrollment Background
  • Working knowledge of state Medicaid Management Information System (MMIS)
  • Demonstrated history of initiating, building and implementing operational programs that have delivered real-world results (significantly improved NPS, operating efficiency, people engagement, etc.)
  • Demonstrated history of simplifying ambiguous and complex environments through the application of highly systematic thinking and structured, simple communication
  • Strong working knowledge of health care related to Quality Management and performance improvement concepts
  • Well versed in regulatory standards pertaining to areas of responsibility (i.e., HIPAA, NCQA, DMHC, CMS)
  • Experience in using provider credentialing management software
  • Ability to multitask and prioritize workload in a fast-paced, evolving environment.
  • Excellent organizational and communication skills.
  • A keen eye for details and ability to spot and document deviations/anomalies
  • An uncompromising approach to meeting/exceeding requirements (or ability to work through steps to have the requirement changed)
  • Strong operations competency required
  • Must be self-starting, hardworking and inquisitive
  • Excellent verbal and written communication skills
  • Strong leadership, time management, and analytical problem-solving skills
  • Must work well with others of all personality types in an intense environment
  • Position Requires:

  • A Bachelors degree in related field or equivalent professional experience
  • A minimum of a three (3) years working knowledge of management and provider enrollment process is required
  • A minimum of three (3) years of experience in managing Medicaid provider enrollment working with a States MMIS or similar health care provider component is required
  • Not required but would love to see:

  • ACA provider enrollment compliance experience is preferred

  • Awesome Benefits:

  • Amazing medical, dental, vision plans with little or no cost to you
  • Generous Paid Time Off
  • 10 Company Paid Holidays per year
  • Short-Term and Long-term Disability & company paid Life Insurance
  • 401(k) Plan with Company Match (day 1 vesting)
  • Company Overview:

    Verisys is the leading provider of the most accurate and comprehensive data and responsive technology tools to inform health care organizations on building and sustaining a fully screened, monitored and compliant workforce. Since 1992, Verisys has been leading the health care industry by providing the highest quality data coupled with deep health care industry experience. We help organizations understand the complexities of sanctions, including disciplinary actions and the implications of licensing requirements in order to maximize their results to hire safe team members, mitigate the risk of reputational damage, financial loss, legal entanglement or regulatory noncompliance. Verisys solutions ensure regulatory compliance and prevent healthcare waste, abuse, and fraud. Verisys products and services include provider data and content, credentialing, primary source verification services, screening monitoring and notification services, identity/authentication tied to credentials management and regulatory compliance products and services.

    At Verisys, you can have a rewarding career on every level. In addition to challenging and meaningful work, youll have the chance to give back to your community, make a positive impact on the environment, participate in a range of diversity and inclusion initiatives, and find the support, coaching, and training it takes to advance your career. Our commitment to individual choice lets you customize aspects of your career path, your educational opportunities, and your benefits. And our culture of innovation means your ideas on how to improve our business and our clients will be heard.

    Verisys embraces diversity and is an Equal Opportunity Employer PWDNET

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