Supervisor, Provider Data & Enrollment
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: Reporting to the Director, Credentialing and Provider Enrollment, the Provider Data & Enrollment Supervisor coordinates the accurate and efficient enrollment of SHCN providers into health plan contracts.
- Responsible for the day-to-day management of the SHCN Provider Enrollment team. Manages the daily operations of enrolling SHCN physicians into SHCN-contracted managed care health plans working closely with other SHCN Managers, SHCN Provider Enrollment, and network representatives
- Specifically, the Provider Enrollment Supervisor is responsible for overseeing and coordinating the full cycle Provider Enrollment function for SHCN practitioners and organizational providers in accordance with SHCN’s contracted health plan credentialing standards and guidelines.
- Develop close and collaborative working relationships with provider and local chapter offices to streamline the accurate submission of participating provider agreements (PPAs) and information to the health plans and to SHCN
- Design, develop, and maintain dashboards to manage national provider target lists and active recruitment pipeline. Lead regular engagement sessions for new recruitment initiatives, network value propositions, and strategic developments
- Conducts sophisticated business analyses and reporting to support Network Development growth and ongoing operations, grounded in deep expertise and functionality with both internal and publicly available data sources
- Work closely with SHCN, its affiliates, and the health plans to reconcile any differences in listings of enrolled SHCN physicians. Coordinates these efforts with and through the local chapter offices and SMG Provider Enrollment and works with SHCN Analytic Team to implement changes in provider data
- Collaborate with and maintain open communication with all departments to ensure effective and efficient workflow and facilitate completion of tasks/goals
- Salesforce Maintenance: tracking provider’s network status, entering new providers, and maintenance as required. Conducts ongoing quality assurance audits of the process to ensure accuracy of provider data entry by staff. Collaborate with internal Salesforce administrators to translate operational needs and inefficiencies into streamlined automated solutions. Produce reports from Salesforce monthly for operational teams and leaders
- Ensure that SHCN has an accurate and up-to-date listing of all employed and SHCN affiliated physicians at all times and that each of the contracted health plans does as well. Prepare and maintain various reports, data and summaries of provider network and enrollment activities. Responsible for administrating and maintaining quality control processes of all Provider Enrollment activities.
- Identifies opportunities for improvements in the process and develops strategies to implement appropriate changes/enhancements
- Develop partnerships with relevant staff at the health plans in coordinating enrollment of SHCN providers; independently troubleshooting issues as they arise. Review and manage provider enrollment processes to ensure that policies/workflows (desktop manuals, policy updates, etc.) are be followed in in compliance with SHCN, State, Federal, and NCQA guidelines as well as contracted health plan directives
- Maintain on-going participation in cross-training activities, ensuring appropriate staff training and coverage of incoming volume
- Actively engage in addressing special projects as they arise, conducting preliminary research and follow-up, and tracking/monitoring to facilitate on-going reporting of project status. Provides valid feedback to the Provider Enrollment Manager on departmental issues and progress
- Perform other functions as assigned
Education / Experience / Other Requirements
- BA/BS required
Years of Experience:
- A minimum of five years of relevant experience in healthcare related environment preferably with supervisory experience in provider network management and/or credentialing/recredentialing environment with knowledge of several sets of national accreditation or regulatory criteria and provider relations/enrollment functions
- Highly proficient with Microsoft Office software (Word, Excel, PowerPoint), and experience with Credentialing, provider data management systems, and SalesForce is highly preferred
- Strong ability to analyze and evaluate data and other provider related problems in order to develop alternative solutions for a positive outcome
- Provides projections and analyses on how potential Network Development deals will impact membership growth and network revenue
- Previous Managed Care and/or Medicaid experience strongly preferred
- Strong ability to be proactive, take initiative, and work independently with minimal supervision as the direct manager of this role is located offsite.
- Ability to manage people and work in team
- Ability to multi-task and prioritize workload, manage multiple priorities, and pay meticulous attention to detail
- Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan provider enrollment and credentialing preferred
- Excellent organizational skills, proven project management expertise; Strong verbal and written communication skill
- Outstanding interpersonal skills, able to quickly establish a trusting rapport with individuals at all levels
- Requisite poise, judgment, and trustworthiness to represent SHCN to internal and external groups
- Maintains information in a confidential manner according to policy
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.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a 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:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.