The Clinical Practice Association Core Services Provider is seeking a Provider Enrollment Manager (Core Services Operations Manager) who will work under the direction of the Director of Provider Enrollment & Third-Party Reimbursement and will supervise the implementation, monitoring and refinement of established policies and procedures. This position will assist the director in analyzing the financial and operational impact of third-party insurer requirements, policies and procedures, state laws and regulations and coding protocols to the JHU Clinical Practice Association's billing operation.
The Provider Enrollment Manager will serve as a secondary contact in absence of director to coordinate JHUSOM third party payer issues and problems with insurers, followed with appropriate resolutions. Assist director in coordinating billing regulatory concerns with the Senior Director, Revenue Operations; Senior Director, Contract Services; Senior Director, Office of Managed Care; Compliance Office and the Director of Information Systems. Extensive experience with PC based and mainframe programs, specifically spreadsheets, data base applications are essential. Position is responsible for all payors with the exception of Medicare.
Specific Duties & Responsibilities:
On a daily basis, provide professional consultation and assistance regarding industry standards, regulations, and payment operations, to department staff, Production Unit Managers, Associate Directors, Directors, and Senior Directors within the SOM and JHBP to improve receivable collectability and staff efficiencies
Provides day to day oversite for Enrollment & Reimbursement Coordinator staff
Proactively research, interpret, and communicate complex Third Party Payer guidelines and specifications that impact accurate claims submission, payments, and appeals that affect PBS operations and the filing and reimbursement of claims for numerous Production Billing Unit Specialties
Attend meetings and in-services with Senior Management throughout the SOM and JHBP as assigned by Director of 3rd Party Reimbursement; also represent department in director's absence
Initiate and hold meetings, onsite sessions, and conference calls with Third Party Payers, Production Unit Managers and staff for issue resolution and education
Reviews and resolves provider enrollment related rejections daily. Follows Provider Not Enrolled (MCOB7) Resolution Policy to enroll deactivated providers immediately
Reviews Provider Enrollment Charge Edits timely to identify and enroll providers who need to be enrolled with RailRoad Medicare
Reviews Provider Enrollment related Claim Edits timely to ensure providers with outstanding enrollment s are captured on the
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