Director, Provider Enrollment

JOB DESCRIPTION

Job Summary

The Director, Provider Enrollment, is responsible for the strategic planning, evaluation, and operational management of the Provider Enrollment department for Baylor Scott and White Health (BSWH). This role will be responsible for overseeing the enrollment of BSWH facilities and providers with government and managed care payers, ensuring all processes comply with regulatory and payer requirements. The Director, Provider Enrollment guides the management team and staff to ensure facility enrollment applications are submitted promptly and payer provider numbers are obtained timely, supporting accurate and efficient payer enrollments and claims submission. Collaborates with Legal, Compliance, Managed Care, Medical Staff Services, Government Finance, Revenue Cycle and other BSWH departments to secure and maintain payer enrollments.

Essential Functions of the Role

• Directs the day-to-day operations of third-party payer enrollment functions and is directly responsible for ensuring payer enrollments and revalidations are completed timely and accurately
• Recommends and implements strategic and operational plans and priorities for provider and facility payer enrollments aligned to BSWH overall business objectives
• Leads and manages department functions, including management of personnel to achieve effective and efficient operations
• Establishes and maintains necessary department specific policies and procedures that support and advance department and organizational objectives
• Develops key operational reports and metrics, monitors department performance indicators, and identifies opportunities for improving processes
• Ensures CMS attestations and applications are filed timely for hospital-based department designations
• Oversees the build and maintenance of current, complete, and accurate provider profiles and rosters
• Establishes horizontal and vertical relationships with colleagues, vendors, and payers to achieve standardization in provider enrollment processes and ensure organizational enrollment expectations are being met
• Collaborates with Centralized Business Services (CBS) billing and insurance collections leadership for resolution of patient accounting system enrollment edits and/or denials to ensure timely reimbursement
• Develops subject matter expertise to serve as resource to Revenue Cycle leadership, colleagues, and team members and proactively stays abreast of industry regulations that impact provider enrollment functions
• Performs other position appropriate duties as required in a competent, professional and courteous manner

Key Success Factors

• Bachelor’s degree in healthcare administration or related field. Master’s degree preferred.
• 10+ years of experience in a large integrated healthcare system
• 5+ years of experience in provider enrollment and/or revenue cycle preferred
• 3+ years of experience in a leadership role
• Strong understanding of governmental and commercial payer requirements, applications and workflows
• Familiarity with PECOS and State Medicaid Provider Enrollment and Management Systems preferred
• Experience collaborating across multiple departments and stakeholders within a large, complex healthcare organization preferred
• Excellent communication skills and ability to create executive-level presentations and deliverables
• Ability to manage multiple priorities, meet key deadlines, and drive performance improvement initiatives
• Strong problem-solving, organizational, and critical thinking skills
• Ability to handle confidential information with discretion

Qualifications

EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
EXPERIENCE - 3 Years of Experience