Director, Provider Enrollment & Provider Onboarding

Location: Steward Medical Group - North

Posted Date: 2/19/2021

Steward Health Care is the largest private, tax-paying physician-led health care network in the United States. Headquartered in Dallas, Texas, Steward operates 35 hospitals in the United States and the country of Malta that regularly receive top awards for quality and safety. The company employs approximately 42,000 health care professionals. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, over 7,900 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services

Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana, and Arkansas, and provides more than 4 million patient encounters per year.

Position Summary:

The Director, Provider Enrollment & Onboarding will report to the Chief Administrative Officer and will lead the department that supports provider growth at Steward Medical Group (SMG). The Director will manage the onboarding and payor enrollment processes for all providers from contract signature to start of employment. The Director will partner internally with Physician Contracting, Operations, Central Verification Office (CVO) and Human Resources.

Key Responsibilities:

• Manage the national Provider Onboarding and Enrollment Teams for by communicating expectations, setting attainable goals and holding staff accountable.
• Work closely with the Physician Contracting, Operations, Central Verification Office (CVO) and Human Resources departments to ensure a streamlined onboarding process.
• Focus on continuous improvement. Change departmental practices/processes to meet changing needs of the business. Audit department work product to maintain quality of work performed through ongoing department-wide quality improvement monitors.
• Minimize losses due to incomplete Provider Enrollments by coordinating start date policies and enforcement with all relevant departments.
• Develop and present escalation grid to SMG Leadership for any provider that is in danger of not being credentialed by their start date.
• Ensure that Provider Onboarding Team is appropriately communicating with providers and that any follow up occurs in a timely manner.
• Continuously evaluate the department processes/protocols and identify areas of improvement to streamline functions and create best practices.
• Develop and maintain appropriate reporting tools to provide critical provider information as efficiently as possible.
• Ensure the timely submission and follow up of contracts and documentation with the payers to ensure that each provider is billing ready upon the commencement of their employment.
• Ensure the timely submission of re-credentialing documentation for each provider.
• Responsible for quality and productivity metrics directly related to Provider Enrollment tasks
• Provide clear direction for staff by establishing goals, objectives, policies, procedures, performance improvement programs, and action plans as needed. Performs all hiring, training, coaching, auditing and evaluations of coding staff. Supervises coding staff and workflow including guidance and training for staff
• Actively and continuously analyzes workflows, organizational structure, staffing assignments or other factors to ensure optimal performance; makes recommendations and modifications, as necessary.
• Work collaboratively with third party payers in order to ensure that billing timelines and revenue opportunities are optimized.
• Effectively communicate the status of the providers with the third-party payers to all stakeholders.
• Maintain unit specific turnaround time levels in accordance with departmental Policy & Procedure. Identify discrepancies, develop solutions, and initiate action plan for correction when necessary.
• Ensure compliance with state and federal regulations, and policies & procedures by region.
• Review A/R reports for all regions to ensure timely Provider Enrollment A/R resolution.
• Oversee overall planning, systems, and controls.
• Other duties or special projects as assigned.

Qualifications:

• Bachelors Degree or equivalent amount of education and experience. Masters Degree preferred.
• 7-10 years of experience working within the healthcare administrative setting with an understanding of the physician on-boarding process.
• 3-5 years of recent management experience.
• Understanding of the payor enrollment process.
• Strong project management, problem solving and analytical skills.
• Exhibit a high energy level with flexibility in work habits to schedule and meet the needs of the provider recruitment and on-boarding effort.
• The ability to work with minimum supervision, set priorities, and follow through to accomplish results.
• Strong computer skills including, but not limited to, Microsoft Outlook, Microsoft Word, Excel, and PowerPoint.
• Demonstrated ability to organize and process complex information and deliver, both verbally and written, in a clear, concise, and articulate manner.
• Strong verbal and written skills to effectively communicate both detail and summary level information to administrators, providers and external departments and managers regarding the recruitment, contracting and on-boarding process for physicians.
• Ability to make policy and procedural decisions and judgments.
• Ability to work independently.

Steward Health Care is an Equal Employment Opportunity (EEO) employer, Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.

Additional Information

Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment with confidence and without fear.

Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.

1. Any COVID-19 related care takes place in designated areas away from other patients and their families.
2. A stringent cleaning policy has been implemented throughout our facilities.
3. A strictly controlled visitor and mask policy is required for patient and colleague safety.