Enrollment Lead Maintenance Coordinator

The Enrollment Lead Maintenance Coordinator is a member of the Credentials Verification Organization (CVO) payer enrollment team responsible for the enrollment of Penn Medicine billable (employed/contracted) practitioners with health plans to ensure Penn Medicine's ability to bill and receive reimbursement for services rendered to patients. The role includes understanding and complying with the enrollment processes of assigned health plans, researching and resolving enrollment related issues, and communicating with internal and external clients. Primary goals under the supervision of the Manager are to identify, evaluate and provide strategic processes in order to accommodate/improve enrollment operations based on payor requirements.

Leads a team of maintenance coordinators working specifically on governmental plan group and provider enrollment applications, providing instruction, and supervising payor projects to timely completion.

Accountabilities

• As an expert in regulatory requirements related to governmental (Medicare/Medicaid) enrollment, responsible for:
• monitoring, identifying and reporting to management trends, changes and issues related to government payers that may significantly impact the Credentials Verification Organization (CVO) and/or Penn Medicine operations;
• proposing changes required to meet these challenges and keep Penn Medicine in compliance with regulatory/payer requirements; and
• implementing agreed-upon workflow changes and provide day-to-day supervision over assigned employed and temporary project-related staff
• Review governmental group applications for accuracy and completeness before submitting them to the assigned governmental agency (Medicare/Medicaid) for processing. Applications include initial, revalidation and deactivation transactions.
• Maintain proficiency in essential systems and processes including;
• CVO Enrollment and Credentialing process and systems; and
• Enrollment databases and other systems required for enrollment with assigned health plans (e.g. PECOS, Promise)
• Responsible for ensuring providers’ enrollments have been completed by the health plans in a timely manner including identifying causes and resolution of enrollment edits (claims held due to suspected enrollment-related issues);
• Analyze the various Enrollment Reports for assigned plans;
• Follow up with government plans on enrollment applications submitted; and
• Serve as liaison between the departments/practices and health plans
• Ensure that provider and practice changes are submitted to the assigned health plans and are accurately processed by the health plans.
• Perform special projects and/or run reports to support the provider enrollment process for the assigned health plans
• Research department/practice complaints and/or independently identify data errors/inconsistencies and other problem areas with enrollment database and resolve or refer issues to manager as appropriate.
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
• Other duties as assigned to support the unit, department, entity, and health system organization

Minimum Requirements

Required Education and Experience

• H.S. Diploma/GED
• 5+ years of experience working in a similar position, preferably in a health care organization
• Understanding of Government plan enrollment policies and procedures

Required Skills and Abilities

• Ability to use Microsoft Word
• Ability to use Microsoft Excel
• Must have the ability to maintain information in a confidential manner in accordance with all regulatory requirements
• Must be able to work independently, take initiative and persevere in obtaining application documentation while communicating in a professional manner. Must demonstrate strong communication skills - verbal/written with providers, internal customers and external contacts.
• Must be able to evaluate that the requirements of a completed application have been met.
• Must be able to exercise good judgment when escalating issues.
• Must be able to work effectively as a member of a team.
• Must be able to meet deadlines.

Department: Medical Affairs - Admin

Position Address: 3600 Civic Center Blvd

As part of our COVID-19 response, this position may currently be offering partial or full remote work. However, in the near future this position will require full or partial on-site work.