Facility Enrollment Supervisor

Essential Job Statements

Manages Team Functions

Develop, manage, and monitor processes, procedures and technical solutions supporting facility credentialing and enrollment for all government, commercial and other third-party payers, including but not limited to oversight of application processes, ensuring compliance with submission/revalidation timelines, maintaining active credentials to submission portals, managing inventory of current source documents, measuring key performance trends, and all other functions necessary to ensure active network participation and maximum payer reimbursement. Develop and prepare standard monthly/quarterly reporting to summarize impact of facility credentialing on enrollment on revenue cycle processes and payer reimbursement.

Supervises Team

Provide day-to-day supervision of facility credentialing and enrollment team. Ensure performance team objectives are clearly set and mentor team to optimize performance, engagement, professional development, and the quality of work experience. Administer employee actions including hiring, performance reviews, promotions, disciplinary actions, and terminations. Coach and develop staff by setting individual performance goals, monitoring progress, and conducting regular check-ins. Reinforce standards and perform quality audits to monitor and optimize performance and reach team goals.

Subject Matter Expert

Build partnerships and engage with key internal stakeholders, including VCUHS IT, Compliance, Legal, Managed Care, Revenue Cycle, and external stakeholders including Ensemble billing and accounts receivables teams, government agencies, and insurance company representatives. Primary contact for all internal and external inquiries regarding facility credentialing and enrollment. Maintain knowledge and ensure compliance with different and/or competing payer policies, regulations, and standards. Represent VCU Health System Authority when attesting to accuracy of application, data and document submissions understanding false representation may result in penalties, fines, or imprisonment. Create and maintain facility credentialing and enrollment database supporting application progress, timelines, and due dates. Create and maintain reference materials, procedures manuals, and data dictionaries for the department. Create and maintain inventory of most current versions of data and documents required for credentialing and enrollment, such as from VDH, DEA, CLIA, JCAHO, liability certificates, Board of Director listings, and other documents.

Performance Improvement and Project Management

Continually identify, analyze, and measure key performance trends (i.e. billing edits, claim denials, and work queue management, etc.). Create and maintain scorecards, dashboards, and ad hoc reporting. Analyze billed charges, medical records, and related documentation. Identify root causes, develop corrective action plans, and implement solutions. Recommend modifications to established practices and procedures. Facilitate interdepartmental workgroups to investigate issues and implement solutions. Make independent decisions and recommendations to senior leadership while utilizing sound judgement.

Other duties

Demonstrate commitment to the mission of VCU Health and the department as evidenced by performing other duties as assigned and/or participating in special projects to support the mission of VCU Health and department. Aid team members and accept alternate assignments, as required, graciously. Perform duties and responsibilities of Facility Enrollment Coordinator positions as needed to manage team scope and meet application deadlines.

Employment Qualifications

Required Education:

High school diploma or equivalent

Combination of education and experience may be considered in lieu of a degree.

Preferred Education:

Higher education degree from accredited program, equivalent relevant experience, or combination of relevant experience and education

Licensure/Certification Required:

Licensure/Certification Preferred:

Minimum Qualifications

Years and Type of Required Experience

Minimum of one (1) year of supervisory experience

Minimum of one (1) year working in provider enrollment or medical billing

Other Knowledge, Skills and Abilities Required:

• Proficient in Microsoft Office Word, Excel, and PowerPoint

• Ability to interpret and apply federal standards and regulations

• Experience evaluating financial transactions from multiple data sources

• Must be highly organized and detail oriented

• Ability to communicate effectively verbally and in writing at all levels

• Ability to work concurrently on multiple projects and prioritize workload

• Strong relationship and collaboration skills to partner closely with internal and external partners

Cultural Responsiveness

Demonstrates a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.

Other Knowledge, Skills and Abilities Preferred:

Working Conditions

Periods of high stress and fluctuating workloads may occur.

General office environment.

Prolonged periods of working alone.

Physical Requirements

Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Crawling, Climbing, Balance, Bending

Work Position: Sitting, Walking, Standing

Additional Physical Requirements/ Hazards

Physical Requirements: Manual dexterity (eye/hand coordination), Hear alarms/telephone/tape recorder, Repetitive arm/hand movements, Finger Dexterity, Color Vision

Hazards:

Mental/Sensory -Emotional

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking

Emotional: Fast-paced environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change

The VCUHS Facility Enrollment Supervisor, reporting to the Director for Revenue Cycle Optimization, provides oversight and support for all facility credentialing and enrollment functions supporting VCU Medical Center and all VCU Health System affiliated hospitals, clinics, pharmacies, and surgical centers, as required by commercial payers, government payers, and other agencies, ensuring active network participation and maximum payer reimbursement. Provides overall supervision for the VCUHSA Facility Enrollment team responsible for accurate and timely submission of facility credentialing and enrollment applications ensuring compliance with payer, legal and regulatory standards.

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.