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Director of Provider Enrollment

Company: Theoria Medical
Location: Novi
Posted on: May 12, 2024

Job Description:

Company OverviewTheoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria teamTheoria's Finance Department is seeking individuals to join its team to oversee and optimize the payer enrollment and credentialing of our physician group. The Director of Provider Enrollment will be responsible for managing the payer enrollment and credentialing process, timely provider enrollments, and resolving any credentialing-related issues that arise. This role will work directly with the Revenue Cycle Management team as well. The candidate must have extensive experience in healthcare credentialing, revenue cycle management, and strong leadership and communication skills.Shift StructureMonday- Friday and some weekends 8:30am-5pm EST, flexibleRemoteEmployment TypeFull-Time, ExemptEssential Functions and ResponsibilitiesAnalyze, lead and manage the credentialing operations, including but not limited to communication with providers, CAQH management, enrollment applicationsOversee a credentialing teamAssist with and perform payer enrollment applicationsManage credentialing vendor relationshipsCoordinate with the revenue cycle management team on credentialing denialsDevelop and implement policies and procedures to ensure accurate and timely submission of payer enrollment applicationsIdentify and resolve revenue cycle issues related to credentialing / payer enrollmentMonitor and analyze revenue cycle metrics, including accounts receivable aging, claim submission and payment turnaround times, and denial rates related to credentialingDevelop and maintain strong relationships with HR and operations departments to ensure a smooth credentialing process.Monitor and manage the entire credentialing and payer enrollment process from A-ZReview and respond to various payor correspondenceRequirements and QualificationsBachelor's degree in healthcare administration or related field7+ years of experience in credentialing/payer enrollment in a healthcare settingAdvanced knowledge of the healthcare industry and a strong financial backgroundClear understanding of billing and collection regulatory guidelines and requirementsVast knowledge in credentialing and payor managementProficient background in reimbursementsExperience in monitoring Clearinghouse activity, reports, and processesExperience in setting up payors with EDI, ERA, and EFT processesKnowledge and experience in startup of a new or established credentialing engagementExperience in managing and leading a team of credentialing professionalsStrong analytical skills and attention to detailExcellent communication and interpersonal skillsAbility to work in a fast-paced environment and manage multiple projects simultaneouslyAgility, strong leadership, problem-solving skillsWorking knowledge of Google Drive and Google suite of applicationsAbility to maintain up-to-date knowledge of Technology and software including but not limited to Monday, Slack, Google suite of Applications, spreadsheets (Excel), Zoom, MS TeamsMust have reliable internet connectionPhysical RequirementsMust be punctual or on time and adhere to the company's Time and Attendance policy.Must be able to remain sitting for the majority of their shift.Compensation and BenefitsSalary $105,000-$125,000401kHealth and dental insurancePTO and holiday payEmployee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Employer retains the right to change or assign other duties to this position.#LI-SM1#LI-Remote#IND-REFRESH-ADMby Jobble

Keywords: Theoria Medical, Novi , Director of Provider Enrollment, Executive , Novi, Michigan

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