A place that gives you opportunity and takes your breath away.

Job Summary

Oversees enrollment processes by providing oversight of the enrollment activities, provider enrollment record maintenance, Third Party Payers, relationship, and reporting activities. Oversees and provides direction to enrollment staff ensuring all staff members are educated to adhere to all accreditation and service standards. Assesses the need to revise enrollment database management systems and processes to meet all applicable regulatory standards, audit processes and quality improvement activities and to ensure customer/provider satisfaction in enrollment and provider record maintenance. Maintain responsibility for regulatory and organizational compliance as it relates to enrollment.

Job Duties

• Develops and maintains enrollment function strategy and provides leadership on its component.
• May supervise enrollment staff to include assigning work, assessing performance, scheduling.
• Acts as the primary enrollment compliance resource with respect to regulatory and accreditation agency programs.
• Assists in coordinating enrollment data for regulatory audits; oversees audits with regulatory bodies related to provider enrollment and primary source verification.
• Participates in on-sight meetings with external parties as a subject matter expert as it relates to provider enrollment.
• Participates in workgroups and provides education as applicable to ensure enrollment standards remain compliant.
• Develops and maintains organizational and provider enrollment criteria, which measures providers according to quality and regulatory metrics.
• Ensures a systematic set of criteria is evaluated and approved by stakeholders.
• Develops and maintains enrollment policies and procedures in which meet all regulatory agency requirements and due dates.
• Develops enrollment strategy and provides leadership during acquisitions and network expansions in support of network goals and initiatives; assists in oversight on execution.
• Acts as the primary enrollment data flow knowledge expert to assist with preparation of surveys, directories, websites, marketing proposals and other data requests.
• Develops and revises, as needed, all documents, forms and standard letters used in the enrollment process.
• Reviews and routinely audits completed credentials files to ensure accuracy and compliance with department standards, and the organization’s enrollment criteria.
• Processes initial enrollment and re-enrollment for providers and organizational providers as needed.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 5 years-Related work experience (Required)

Skills

HR Policies, Standards And Procedures; Communication; Office Politics And Confidentiality; Teamwork; Computer Literacy

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Our Vision & Values

Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities.

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE: We treasure colleagues who humbly strive for excellence.

LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.