Provider Enrollment Team Lead

About Us

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia emergency medicine hospital medicine pathology and radiology. Focused on Revenue Cycle Management Ventra partners with private practices hospitals health systems and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues enabling clinicians to focus on providing outstanding care to their patients and communities.

Come Join Our Team!

• As part of our robust Rewards & Recognition program this role is eligible for our Ventra performance-based incentive plan because we believe great work deserves great rewards

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Job Summary

The Provider Enrollmentteam leadis responsible forassistingwith the day-to-day activities of the Provider Enrollment Departmentactas the first line leader to staff andcontributesto the development of processes and procedures. Monitor the quantity and accuracy of activities performed by subordinate staff. Development of work plansdevelopandmaintainperformance standards associated with various functions. Expert knowledge and independent application of state and federal regulations governing healthcare. A high degree of applied knowledge of provider enrollment nuances. Staff training andassistingstaff to resolve complex provider enrollment issues. Perform deep-dive audits of specific accounts payers or the work performed by an individual. Draft processes and procedures consistent with applicable regulations and/or specific payers. Interpretation

Essential Functions and Tasks

• Supervise train and support provider enrollment staff responsible for licensing provider enrollment privileging enrollmentreappointmentsand/or maintenance of professional credentials.
• Work with Manager Provider Enrollment to complete employee relation duties as necessary such as coaching mentoring corrective action or similar.
• Review edit and process employee timecards and schedules.
• Assist with or prepare annual performance reviews for provider enrollment staff.
• Send Medicare Revalidation reminders for all providers.
• Monitor held claims in AIMs/Work release emails for held claims.
• Conduct client calls to provide status updates on clients.
• Work with AR toresearchproviderenrollment related denials.
• Work with Clean Claims to research provider enrollment related rejections.
• Ensure any questions regarding releases are answered in a timely fashion.
• Responsible for ensuring Medicare provider enrollment items are completed timely.
• Work with Client Management to provide support on client concerns and updates.
• Enrollment for special projects and provide additional support as needed.
• Meet staff for one-on-one touch base on performance/feedback concerns.
• Work with Payments for requested EFT enrollments/updates.
• Develop maintain and track various performance measures.
• Prepare status reports and perform special projects as required.
• Performs other related job duties as assigned.

Education and Experience Requirements

• High school diploma or equivalent required college degree preferred.
• Two (2) years experience in supervision.
• Two (2) years experience in Provider Enrollment.
• Knowledge of NCQA standards as it relates to provider enrollment and health plan enrollment.

Knowledge Skills and Abilities

• Excellent verbal and written communication skills.
• Proficient in Microsoft Office Suite and proprietary database applications.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to multi-task manage priorities and meet critical deadlines.

• Ability to work independently and in a fast-paced environment.

• High level of awareness of pertinent details; excellent organizational skills.

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location skill set experience qualifications and other job-related reasons.
• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health

Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates and all qualified applicants will receive consideration for employment without regard to race color ethnicity religion sex age national origin disability sexual orientation gender identity and expression or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities as needed to assist them in performing essential job functions.

Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global scammers may attempt to conduct fake interviews solicit personal information and in some cases have sent fraudulent offer letters.
To protect yourself verify any communication you receive by contacting us directly through our official channels. If you have any doubts please contact us at to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on of Accessibility
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Employment Type : Full-Time
Experience: years
Vacancy: 1