• Enrollment Team Lead, Medical Staff, Days, 80 Hrs / 2 wks
• Location: Mercyhealth Trauma Center; Janesville, WI and Rockton Ave Campus; Rockford, IL.

The Enrollment Team Lead works as a liaison between Medical Staff Office management and partners, communicating policies, procedures and workflows, as well as providing training and monitoring work volumes. Performs other duties as assigned.

• The Team Lead will provide consistent, accurate and timely enrollment support, enhancing Mercy System's ability to provide professional services, including timely and accurate verification, validation and documentation of the information provided by all applicants; ensures provider files are kept confidential at all times; coordinates operations with other departments to ensure smooth workflow; assists with short-term and long-term goal setting.
• Understands and maintains an in-depth knowledge regarding the requirements for credentialing physicians and other allied health provider types with Wisconsin and Illinois Medicaid, Medicare, Medicaid, and third-party payers as necessary.
• Participates in provider enrollment application preparation, finalization, submissions, follow up and resolution.
• Assists with accurate and complete data entry of credentialing and enrollment information into the credentialing database. Develop into database super user and work with database support staff to ensure updates are implemented.
• Responds to inquiries regarding enrollment status, handles provider correspondence as necessary to process enrollments, and maintains knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate.
• Assists with the coordinator hiring process and training of new employees. Provides mentoring to staff members and assists with performance appraisals, disciplinary actions, and other HR relations.
• Audits and monitors all Enrollment processes and individual partner performance to assure compliance with department policies and procedures, State, Federal, and NCQA guidelines, as well as contracted health plan directives.
• Assists in overseeing collaboration between Enrollment, Medical Staff Office and Revenue Cycle to ensure effective communication regarding new providers. Ensures timely communication with operational leaders on status of enrollment approvals. Provides reports as necessary for Patient Accounts, Patient Access, etc. with enrollment confirmation information necessary for timely billing.
• Obtains and maintains information necessary for credentialing Mercyhealth providers with laboratory certification with the Illinois Department of Public Aid, as applicable. Monitors expiration dates and updates to ensure claims are paid in a timely manner.
• Responsible for investigation or follow-up of claims work queue and communicate results to Patient Financial Services.
• Understands facility enrollment, as appropriate.
• Serves as organizational resource for government/third party payer credentialing regulation and in maintaining systems which are consistent with current industry standards. Maintains familiarity with healthcare AR revenue cycle management and what is required to attain optimal collection performance standards.
• Works closely with leadership to problem solve situations appropriately and independently; proactively prioritizes needs; shows attention to detail; communicates clearly and concisely; possesses excellent interpersonal, presentation, and written communication skills.
• Ensures Department leadership is informed of any unusual and significant issues that may affect workflows related to Government/Third Party Payers and Enrollment functions.
• Oversees day to day operations of Enrollment team including fielding partner inquiries, remote work partner scheduling, and ordering supplies for offices.
• Other duties and projects as assigned.

Associates degree AND 3 years of experience in a healthcare-related environment, preferably with credentialing/enrollment,

OR 5 years of experience working in a healthcare-related environment, preferably with credentialing/enrollment required.

Bachelor's degree preferred.

Previous supervisory experience preferred.

PESC preferred or commitment to pursue certification within 1 year.

CPCS or CPMSM preferred or commitment to pursue certification within 3 years.

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

This position is considered sedentary work exerting up to 15 pounds of force occasionally. Manual dexterity to operate a keyboard, telephone, fax, scanner and other office equipment as necessary to perform duties. While performing the duties of this job, the employee is frequently required to sit; reach; use fingers to handle, finger and feel; and talk/hear. Employee will occasionally stand; walk; and stoop/kneel/crouch/crawl. Specific vision abilities required for this job include frequent close vision, distance vision, and ability to adjust focus with occasional color vision, peripheral vision and depth perception. Repetitive finger/wrist movement associated with the use of a keyboard.