Manager, Payor Enrollment, Government Plans
Wellstar Health Systems

Facility: 1800 Parkway Center

Job Summary:

This individual will make sure that provider applications are completed accurately and submitted to all governmental payors in a timely way. The Manager will work with the governmental payors, WellStar operations, the WellStar managed care department, the MBGO billing team and the WellStar credentialing staff to make sure that the submission process runs smoothly and timely, no enrollments are missed and there is a timely and appropriate response from the managed care payors to avoid delays in enrollment.

Core Responsibilities and Essential Functions:

Monitors and audits workloads to ensure tasks are completed timely and correctly Interviews, trains, counsels and evaluates staff. Make sure that all new staff are appropriately trained and oriented. Works with the enrollment team to monitor responses from governmental payors to enrollment requests and assists with follow-up as needed to avoid denied applications and delinquent responses Monitors reports and takes any necessary action to make sure that Medicaid and Medicare revalidations and any expirable documents are completed and provided to governmental payors timely and accurately Insures the team has all of the information and tools needed to complete applications, follow-up requests and post enrollment actions for all government payors Makes sure that credentialing software is updated with new provider enrollment requests, changes and new information Assists Director in management of team payroll and workload

Required Minimum Education:

• Bachelors Business Administration/Management-Preferred

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 4 years Credentialing, billing, managed care and/or customer service Required
Minimum 3 years Exceptionally strong skills in using internet browsers and the Microsoft Office Suite of products Required
Minimum 3 years Database management skills (data entry and editing) Required
Minimum 4 years Working knowledge of enrollment process with Georgia Medicaid including the GAMMIS application portal and Power of Attorney for Payee requirements Required
Minimum 4 years Working knowledge of enrollment process with Medicare, including the PECOS application portal Required

Required Minimum Skills:

Self-directed, ability to work autonomously in a fast-paced environment and prioritize multiple assignments without direct supervision High
Exceptionally strong organizational skills High
Exceptional detail orientation High
Ability to prioritize projects and meet competing and demanding deadlines High
Strong communication skills, both verbal and written High
Strong interpersonal skills, ability to interface comfortably with providers, managed care organizations, colleagues and senior leadership. Demonstrates effective communication skills to manage interpersonal relationships both internally and externally. High
Exceptional customer service skills; ability to understand and address core issues High

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