Provider Enrollment Supervisor

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Supervisor of Provider Enrollment assumes a pivotal role in overseeing the day-to-day activities of the Provider Enrollment team. This individual is responsible for ensuring the team's productivity and holds accountability for the outcomes produced by the Provider Enrollment staff. Monitoring and reporting on the operational facets, metrics, and data accuracy within the provider enrollment department are key responsibilities. The role involves the development of specific goals and strategic plans to guide the team, offering insights and recommendations on departmental policies and workflow processes.

To enhance operational efficiency and align with the overarching goal of enhancing the overall provider experience, the Supervisor implements targeted programs within the department. This entails leveraging extensive functional knowledge, managerial acumen, and leadership expertise to achieve specific business objectives. Staying abreast of the technical intricacies of provider enrollment is crucial, as the Supervisor manages complex situations to fulfill business unit goals.

The position involves the implementation, monitoring, and assurance of the accuracy of cross-functional procedures and programs. In addition to addressing immediate challenges to optimize organizational performance, the Supervisor acts as the Plan's point of contact for external providers and collaborates with other WellSense staff to resolve enrollment-related issues effectively.

 * Looking for candidates who preferably reside in Massachusetts or boarding states.  There will be a requirement to attend meetings in the Boston office 1x per month.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities:

·           Lead the recruitment process by conducting interviews, making hiring decisions, and providing ongoing supervision for the Provider Enrollment team. Facilitate training sessions for both new hires and existing staff under the guidance of the Team Lead.

·           Supervise day-to-day activities of the Provider Enrollment staff, ensuring timely inventory management and optimal resource allocation for maximum efficiency. Assign tasks strategically to achieve department objectives and enhance successful turnaround time results.

·           Establish job performance standards related to volume, turnaround time, and data quality. Regularly measure and report on departmental and individual performance, utilizing metrics to drive continuous improvement.

·           Participate in developing cross-departmental processes to meet contractual and NCQA compliance, with a focus on overseeing practitioner terminations. Monitor and report adherence to compliance standards across the organization.

·           Manage all aspects of provider enrollment, ensuring accurate loading of provider hierarchy and data in relevant systems. Communicate and comprehend unique arrangements, facilitating precise enrollment of providers with such arrangements.

·           Ensure documentation of all Provider Enrollment processes and job aids, while spearheading efforts to develop standardized training modules for Provider Enrollment and other Onyx users.

·           Serve as the primary contact for ongoing data issues, overseeing cleanup efforts from identification to handoff to Provider Relations. Collaborate with Finance/analytical staff to quantify financial implications, and facilitate communication with providers and ongoing documentation with Contracting staff.

·           Develop, manage, and utilize a standardized set of reports for Provider Enrollment Specialists, streamlining the enrollment process. Oversee the entry of provider-related data into Onyx, ensuring data integrity through leadership of cross-functional workgroups.

·           Establish and implement a data audit function for the Department, reporting results to internal and external audiences in compliance with the Model Audit Rule.

·           Monitor provider enrollment issues, proactively identifying and troubleshooting issues affecting provider payment. Ensure the appropriate administration of the end-to-end enrollment process.

·           Perform other duties as assigned by the Manager.

Supervision Exercised: 

• Supervises 6 to 10 staff.

Supervision Received: 

• General supervision is received weekly 

Qualifications: 

Education Requirements:

• Bachelor’s degree in Business Administration or related field or equivalent combination of training and experience. 

Experience Requirements:

• At least 5 years of related experience in a healthcare field.
• Minimum of 1year of progressively responsible Provider Relations, Provider Enrollment, or similar managed care/healthcare insurance experience.
• Minimum of 3 years in a supervisory capacity preferred. 

Preferred/Desirable:

• Experience with managed care,Medicare and Medicaid contractual requirements.
• Project management skills.

Certification or Conditions of Employment: 

• Pre-employment background check

Competencies, Skills, and Attributes: 

• Demonstrated competence using Microsoft Office products especially Excel and Access; familiarity with FACETS and/or Onyx helpful.
• Proven demonstration of effective communication skills (verbal and written), and interpersonal skills to lead and direct the efforts of others, both internally and externally.
• Effective collaboration and proven process management skills
• Ability to be flexible and work independently. Ability to manage multiple tasks and possess excellent organizational skills.

Working Conditions and Physical Effort: 

• Work is normally performed in a typical interior/office work environment
• No or very limited physical effort required. No or very limited exposure to physical risk
•  Regular and reliable attendance is an essential function of the position.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees