Manager, Provider Services, Anesthesiology - Emory Healthcare

Prefered Qualifications: Proficiency with Verity, MSOW, and Qgenda a plus.  Prior experience with Anesthesiology (CAA, CRNA, MD/DO) credentialing preferred. 

JOB DESCRIPTION:

• Manages credentialing functions for a large division or department (200+ providers).
• Ensures compliance with policies, procedures and regulatory guidelines.
• Supervises credentialing staff and coordinates all clinical privileging, reappointments/re-credentialing, provider licensing and billing enrollment.
• Coaches staff to ensure high performance standards and timely onboarding of providers.
• Participates in the development and administration of departmental policies and procedures.
• Develops and executes the strategic direction of the credentialing and enrollment team to ensure provider friendly and efficient processes to ensure a consistent direction across the department.
• Facilitates and oversees the major processes for credentialing of physicians and advance practice providers into Emory Healthcare Care (EHC), Emory Medical Care Foundation (EMCF), Emory Specialty Associates (ESA), and The Emory Clinic (TEC) and payor enrollment with Managed Care, Medicaid, and Medicare Enrollment working individual files as needed Develop collaborative relationships with key stakeholders, including – departmental physician, anesthetist, NP/PA, and administrative leadership, system credentialing and enrollment leadership, Grady offices of System Credentialing, and the Office of Managed Care.
• Educates and advises staff on Credentialing and Enrollment policies and partners with the centralized credentialing team and hospital medical staff offices to streamline onboarding processes and ensure practices comply with organizational and legal requirements.
• Ensures providers are licensed, privileged, and enrolled in billing by their start dates. Partners with HR to coordinate hiring dates with credentialing and enrollment timelines.
• Teaches and leads continual process improvement and customer service processes.
• Meets with new providers with the goal of seamlessly matriculating them into the Emory system.
• Ensures direct reports correctly coordinate network and badge access for each location, billing orientations, department orientations, provide appropriate HR contacts, etc.
• Partners with Finance, Patient Financial Services and Anesthesia Coding team to ensure proper billing provider set up in EPIC, billing effective dates for all payors are updated and all credentialing and enrollment edits are reviewed and resolved timely to achieve maximum reimbursement for services rendered. Other duties as assigned.

MINIMUM QUALIFICATIONS:

• Bachelors degree in healthcare or business related field and at 5 least years of comprehensive credentialing and enrollment experience in an acute care hospital, managed care, or credentialing verification organization which includes two years of supervisory experience.
• Must have previous experience working with physicians. Previous supervisory experience of at least one year.
• Planning and organizational skills, with the ability to manage many different projects and people at once.
• Ability to communicate tactfully, verbally and in writing with department heads, managers, coworkers, and vendors to resolve problems and negotiate resolutions.

PHYSICAL REQUIREMENTS:

• (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS:

• Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Proficiency with Verity, MSOW, and Qgenda a plus.  Prior experience with Anesthesiology (CAA, CRNA, MD/DO) credentialing preferred.