Manager Enrollment Operations - Hybrid

Manages the Enrollment Operations team and operational processes to deliver accurate and timely network and application system access that maximizes revenue from reimbursements for Dartmouth Health. Responsible for overseeing the Provider Network Participation process for all relevant Commercial, Managed Medicaid, and Governmental Health Plans, directly impacting the financial health of Dartmouth Health. Responsible for overseeing the Dartmouth Health Facility Network Participation process for all Governmental Health Plans. Manages the provider documentation process, per regulatory requirements, in support of clinical operations to accurately capture claims and reimbursements. Supervises all Dartmouth Health Epic HB and PB Enrollment work queues to minimize insurance related holding A/R. Oversees holding or denied insurance claim follow-up, including patient record review and transfer of claims to the appropriate parties. Responsible for identifying key operational requirements of health plan contracts and evaluating the overall impact on operations. Collaborates with internal staff, D-H Senior Leaders, D-H managers, Affiliate leaders as well as health plan and billing representatives to develop and implement appropriate operational changes. Acts as a key contributor in provisioning and maintaining the Dartmouth Health provider records in the EMR (e.g. produces verified provider credentials, determines appropriate access dates, granting applicable system admitting privileges, etc.) Manages the Dartmouth Health bill areas in the EMR, ensuring appropriate billing and revenue routing. Manages Enrollment Operations team members and provides training/education and support to Dartmouth Health Affiliate enrollment staff. Responsible for interviewing, hiring and onboarding of staff including completion of orientation checklists and acting as preceptor to new employees. Responsible for creating and maintaining Enrollment and network access policies, procedures and job aids. Responsible for understanding, dissemination and implementation of all health plan rules and regulations. Assists in the drafting and negotiations of new and amended Delegated Credentialing health plan contracts. Manages NCQA compliance and accreditation standards and health plan audits. Stays current with CMS requirements specific to provider participation and reimbursement. Serves as primary liaison between D-H credentialing, D-H contracting, Conifer RMD and external payors and facilities. Collaborates with the Senior Director for AR Management and other Conifer staff to support revenue cycle best practices. Responsible for developing and tracking payor metrics and reporting metrics to various levels of senior and executive leadership. Is the Enrollment and application system access subject matter expert. Is a key contributor in the development and maintenance of processes that support Dartmouth Health. Performs other duties as required or assigned. Bachelor’s degree and a minimum of four years enrollment experience or the equivalent in education and experience required. Three (3) years of supervisory experience is preferred. Two (2) years of member enrollment experience preferred. Experience with Commercial, Governmental, and Managed Medicaid health plans. High-level proficiency and experience with Health Plans, NCQA, and CMS standards. Demonstrated leadership, project management, time management and organizational skills required. Excellent communication and interpersonal skills required. Experience with revenue cycle improvement preferred. Experience with Epic preferred. High attention to detail and accuracy. High technical aptitude with an ability to create and distribute system reports for various levels of senior and executive leadership. Demonstrated proficiency in managing systems. None