The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.
Northern Light Health
Department: Credentialing
Position is located: Cianchette Professional Blding
Work Type: Full Time
Hours Per Week: 40.00
Work Schedule: 8:00 AM to 4:30 PM
Exempt: Yes
Summary :
This position will provide best practice administrative management services for all aspects of provider enrollment and re-credentialing performed on behalf of Northern Light Health. Leadership accountability will be expected in managing provider enrollment operations and activities by demonstrating current practices and by using and integrating technology. The Manager will be responsible for developing systems that support their organization’s mission and strategic plan. A key performance area will be regulatory and NCQA accreditation knowledge and compliance.
Responsibilities :
Program Management
Plans, implements, organizes and oversees provider and facility enrollment
- Assists in developing, influencing and implementing system design and enrollment workflows.
- Leads a comprehensive and technologically driven enrollment and recredentialing process to ensure continuity, accuracy, completeness and timeliness.
- Protects the integrity and security of the database.
Designs and directs the use of process and performance improvement data to implement change
- Collaborates with key staff and stakeholders on managing an ongoing reporting process that is accurate, timely and action driven.
Controls the administrative support of operating documents
- Ensures that all enrollment records are accurate.
- Protects permanent records by managing a secure record retention process.
Plans and manages strategic and daily activities of the department
- Responsible for adequate staffing.
- Collaborates, develops and implements long and short-term goals.
- Establishes standards and analyzes workflows that promote best practices and champions innovation.
- Manages team to align with departmental budget.
Plans and manages an effective meeting management system
- Leads team meeting activities (agenda development, documentation, follow-up and communication).
- Provides guidance on accreditation, regulatory issues, payer requirements, best practices, meeting outcomes and resolution.
Collaboration
- Serves as a liaison between the enrollment team and Medical Staff Offices, revenue cycle, payer contracting, and payer points of contact.
- Influences and leads technology integration and migration with other information systems.
- Manages requests to generate customized reports and provide added services.
Regulatory & Quality Compliance
- Interprets, develops and implements practices of all systems and functions to ensure continuous compliance with NCQA accrediting standards.
- Manages client audits, findings and reports.
- Seeks and maintains departmental certifications.
- Develops and oversees operational quality indicators which reflect meaningful measures of quality of services provided. These indicators are monitored on a scheduled basis and corrective action is instituted, when required.
- Assure that workflow, information systems and policies and procedures are current and appropriately maintained.
Leadership
- Supports education, professionalism, practice-based learning and systems-based learning.
- Responsible for recruiting, training, mentoring, evaluating and disciplining staff.
- Cultivates positive interpersonal relationships with clients, medical services professionals, practitioners, ancillary staff and senior management.
- Promotes ongoing education.
Other Related Functions
- Assures that human resources are managed in accordance with organizational policies and procedures.
- Establishes work standards; promote best practice by continually assessing and championing innovation and best practice.
- Provides ongoing communication with relevant medical staff leaders and hospital administration.
- Assist with delegated agreements, including credentialing audits.
- Other Duties
Other Information :
- Certified Provider Enrollment Specialist (CPES) or Provider Enrollment Specialist Certificate (PESC) required, or achievement of certification as determined by leadership.
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) required, or achievement of certification as determined by leadership.
- MD Staff Certified Specialist preferred.
Competencies and Skills
- Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
- Acts Strategically: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.
- Adobe Acrobat
- Applies Business Acumen:Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.
- Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
- Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
- Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.
- Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
- Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
- Fosters Innovation: Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.
- Influences and Inspires: Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.
- Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
- Word processing, spreadsheets, data entry, database experience and other computer related skills.
- Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.
- Presentation software with the ability to create presentations with the ability to incorporate animation, audio, video, time delays, as well as designing themes and variants with animations and effects.
- MS Teams
- Word process application with the ability to create and edit documents, format, use tables, apply footnoting, create table of contents and mail merge techniques.
- Multi-line phone, scanner, photocopier, fax, and internet.
- Experience with operating a network.
- Public Speaking
- Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability .
- Seeks Process Improvement & Applies System Thinking: Possesses and gains insight into situations, problems and processes. Understands the interconnection between organizational elements. Deconstructs problems and systematically investigates the various components. Considers the impact of actions on the entire process/system. Detects problems and opportunities, recognizes important information, and links various data to trace potential causes and relevant details.
- Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.
- Troubleshooting
- Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.
- Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
- Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
- Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
- Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
Education
- Required Bachelor's DegreeIn lieu of education, two years of experience is required per year of required education, exclusive of the minimum experience identified above.
Required Experience
- 1 year/years of Leadership Experience
- 5 year/years of Relevant Work Experience
Working Conditions
Work with computers, typing, reading or writing.
As an integrated health delivery system serving Maine, Northern Light Health is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our state. Our care team—in hospitals, primary and specialty care practices, long-term and home healthcare, behavioral healthcare, and ground and air medical transport and emergency care—are committed to making healthcare work for you: our patients, communities, and employees.
Questions? Contact Talent Acquisition:
phone: 207-973-7100
email: [email protected]
Brewer, Maine, Corporate Office, Cianchette, Foundation, Finance, Human Resources, Legal Services
