HCA, Hospital Corporation of America Provider Enrollment Credentialing Supervisor - Urgent Care in Coppell, Texas
The HCA Physician Services Group (PSG) is the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 750 practices, Urgent Care Facilities, and partners with HCA’s 165 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career.
The Credentialing Enrollment Supervisor oversees the daily operations and activities of the credentialing and enrollment department in accordance with AAAHC, NCQA, state, and CMS guidelines. This position is responsible for managing people, relationships with client health plans, network management personnel and oversight of processes involving credentialing, practitioner enrollment and delegated credentialing agreements.
- Oversight of all activities of the provider enrollment and credentialing for each health plan, including Medicare and Medicaid.
- Oversight of all activities for provider enrollment and credentialing for new entities and acquisitions.
- Develop, implement and manage processes to create, update, and maintain practitioner files for appointment and re-appointment while following protocols and guidelines set forth by the CPC.
- Complete ongoing file review on a regular basis to identify objectives, error rates, and use data as an opportunity to train and educate.
- Establish and maintain production and quality metrics for team specialists and lead for optimal unit performance.
- Communicate and work to improve interdepartmental relationships with recruiters, operations, billing, and internal/external leadership of the urgent care service line.
- Works closely with Revenue cycle staff to minimize delays in claims submission and gaps in enrollment.
- Creates and revises credentialing policies and processes, workflows, and desk top procedures to ensure compliancy with all regulatory and contractual credentialing requirements.
- Advises on the development of critical corporate guidelines and best practices working closely with credentialing processing centers.
- Identify and communicate all concerns regarding enrollment and credentialing, including barriers that prevent timely completion. Implement corrective action plans.
- Assist in preparation for state and federal audits, responding to auditor’s inquiries and preparing responses to findings working closely with the lead coordinator.
- Conduct quarterly, semi-annual, and annual credentialing reviews and prepare reports for Director of AR and governance meeting.
- Establish high performance goals that are measurable and hold team accountable.
- Bring together joint initiatives around internal/external departmental boundaries and facilitate shared ideas to ensure successful outcomes.
- Manage multiple projects under tight deadlines.
- Works closely with revenue cycle leadership to ensure excellence in enrollment/credentialing activities. KNOWLEDGE, SKILLS, ABILITIES:
- High School Diploma or higher level education.
- 3 year management experience leading credentialing and enrollment in managed care, work comp, and governmental plans for multiple states required, including Medicare and Medicaid required.
- 3 year revenue cycle experience required.
- Current Certified Provider Credentialing Specialist (CPCS) preferred.
- Knowledge of urgent care and billing/credentialing preferred.
- Knowledge of provider/entity enrollment and credentialing requirements.
- Knowledge and understanding of AMA, AOA, NPPES, DEA, DPS, NPDB, SAM, EPLS, OIG, and AAAHC.
- Ability to analyze and interpret a wide range of information.
- Ability to plan, assign, supervise, and evaluate the work of others, and to monitor goals, objectives, deadlines and priorities.
- Ability to manage multiple projects effectively while facilitating group success.
- Ability to effectively communicate with leadership, health care representatives, credentialing processing centers, and all team members of the urgent care service line to ensure optimal success.
- Maintain knowledge and ensure compliance of Credentialing /Enrollment requirements from the CPC, state, government, AAAHC, NCQA guidelines.
- Maintain knowledge of commercial, governmental, and occupational credentialing /enrollment requirements and standards.
- Must be able to adapt quickly to changing environment as new urgent care centers are established and follow established process for selected entity.
- Excellent communication and written skills to communicate with doctors, APPs, CPC, operations and other parties of the urgent care service line regarding credentialing requirements and deadlines.
- Strong analytical, interpersonal, communication, conflict resolution, problem solving and organizational skills required.
- Must be able to present formal communications on a weekly, monthly quarterly, yearly basis in spreadsheet/graph format to Director/Urgent Care Leadership regarding updates, status, data analysis, audit findings, timelines, and other pertinent information for planning, accountability, and growth purposes.
- Practice and adhere to the company Mission & Value Statement and Excellence Strategy.
- Strong written, phone, and verbal communication skills, proven ability to communicate with physicians, APPs, and leadership.
- Perform annual evaluations for direct reports with development goals and coaching as needed.
- Ability to interview, hire, and fire.
- Stay abreast of industry changes in healthcare, including enrollment and credentialing.
- Knowledge of and adherence of HIPAA regulations and guidelines. #CB
Title: Provider Enrollment Credentialing Supervisor - Urgent Care
Location: Texas-Coppell-Urgent Care Management
Requisition ID: 24900-48459