Manager of Government Enrollment and Physician Credentialing


Fantastic opportunity to grow with Alliance HealthCare Services in this unique role

The Manager of Government Enrollment and Physician Credentialing will supervise all aspects of Alliance Healthcare Services government healthcare provider enrollment and physician/physicist credentialing programs. The primary responsibility of the Manager of Government Enrollment and Physician Credentialing is to ensure that Alliance Healthcare Services is in 100% compliance with all Medicare and Medicaid regulations and timely filing requirements. The Team Member in this position is the guardian of the Alliance Healthcare Services active Medicare and Medicaid certifications with the responsibility for ensuring that there is never a time when Alliance Healthcare Services is in jeopardy of having any certification revoked or terminated. This is a corporate level task that requires the Manager of Government Enrollment and Physician Credentialing to work directly with all other Alliance Healthcare Services departments and divisions to provide the requisite information needed to complete initial and revalidation applications accurately and within the timeframe required by Medicare and Medicaid. In the event Medicare or Medicaid sends back a development request, the Manager of Government Enrollment and Physician Credentialing will ensure accurate and timely responses that include engaging the legal department to develop an appeal when Alliance Healthcare Services disputes the position Medicare or Medicaid is taking related to any particular regulation. This position supervises the Team Members who complete the Alliance Healthcare Services provider enrollment applications, revalidations and updates for governmental healthcare programs, including Medicare and Medicaid. The role is responsible for ensuring that all Alliance Healthcare Services independent diagnostic testing facilities (“IDTFs”) pass onsite inspections by Medicare and State Medicaid inspectors in order to remain compliant with the IDTF performance standards and other Medicare/Medicaid requirements. The Manager develops precise and rigorous training materials and training programs for newly hired team members. When there are significant changes to either the Medicare or Medicaid regulations or a change to the Alliance Healthcare Services ownership structure, the manager prepares training materials and specific training programs for all internal staff including the Manager's direct reports, Business Development, Sales, and Operations on the issues and their impact to the IDTF site operations. The Manager of Government Enrollment and Physician Credentialing is the subject matter expert on Medicare and Medicaid regulation and acts in the capacity of being a resource to others in the company.

The Manager also has responsibility for the physician and physicist credentialing for all locations, retail, wholesale, RAD360 and Oncology. This positions manages all physician and physicist credentialing activities including policy development, oversight of the source verification qualifications and management of the credentialing committee to stay in compliance with the Joint Commission standards. On a monthly basis, the Manager will track upcoming license and insurance expirations to ensure all physicians and physicists remain eligible to perform services on behalf of Alliance. The Manager ensures all credentialing files are complete, accurate and available in order to comply with Joint Commission audits.

The Manager of Government Enrollment & Physician Credentialing is responsible for the implementation of the systems and processes necessary to support efficient and effective activities within the Government Enrollment and Physician Credentialing department. This includes developing and using tracking reports to monitor department and individual Team Member results to ensure key performance indicators are met each month.

Specific duties include, but are not limited to:

  • Leads all aspects of the Government Enrollment and Credentialing department including process improvement initiatives and implementation of processes to improve efficiency and effectiveness of the team. Meets or exceeds all personal and department Key Performance Indicators (KPI's).
  • Oversees the 100% accurate and 100% timely compliance of government provider enrollment applications and updates, as well as ensures that IDTF inspections are passed and IDTF performance standards and other Medicare/Medicaid requirements are compliant.
  • Ensures that the Physician Credentialing team is implementing and following all policies and procedures to ensure efficiencies and compliance with the Joint Commission standards for physician and physicist credentialing.
  • Provides direction and training to staff to ensure department meets production and quality assurance goals defined for this position. Provides assistance to other Alliance departments and works closely with the Legal department in developing communication and training with respect to Medicare and Medicaid regulations.
  • Responsible for oversight of all Medicare and Medicaid regulations including staying abreast of new guidelines and their ramifications to Alliance as well as developing new policies and procedures to support new or changing regulations.
  • Bachelor's Degree or equivalent experience required.
  • Seven (7) to Eight (8) years of work experience in Healthcare, Business Management or Public Health Administration.
  • Minimum of two (2) years of management experience with physician and physicist credentialing.
  • Five (5) to seven (7) years of progressive managerial experience.
  • Minimum five (5) years' experience enrolling healthcare providers in Medicare and Medicaid with 100% timely filing compliance and 100% accuracy.
  • Experience with IDTF Medicare/Medicaid enrollment including direct knowledge of the approximate 1,400 pages of Medicare regulations that govern IDTF's.
  • Direct interaction with the Medicare MAC's and the State Medicaid Agencies.
  • Updating and managing the accuracy of the Alliance data stored in the Medicare PECOS system.
  • Developing and implementing improved workflow processes.
  • Highly organized with excellent written and verbal communication skills.
  • Excellent analytical and critical thinking skills, to include the ability to read, extract and interpret information.
  • Superior logic, problem solving and project implementation skills.
  • Extensive experience creating, using and manipulating Excel Spreadsheets.
  • Management experience preparing and successfully passing Joint Commission Credentialing Accreditation.
  • Ability to perform comfortably in a fast-paced deadline-oriented work environment.
  • Microsoft Office skills required.
  • Must be independent and self-motivated requiring minimal supervision.
  • Knowledge of the ViStar eVips system a plus.
  • Previous employment by Medicare or a State Medicaid agency a plus.
  • Previous experience working with complex ownership structures and accurately reporting those ownership structures to Medicare and Medicaid a plus.

Key words: provider enrollment, IDTF, government enrollment, credentialing, ancillary, managed care, medicare, medicaid


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November 7, 2018