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Employment Type:

Full time

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Description:

Provides leadership and establishes direction for a comprehensive payer credentialing and enrollment team for MercyOne Regional Health Ministry (RHM). Combines expert knowledge of payer credentialing and enrollment, process improvement and change management to effectively build and lead a centralized and integrated credentialing team across MercyOne RHM.

Reporting to the MercyOne Population Health Services Organization (PHSO)’s Director of Operations, the Manager of Payer Credentialing and Enrollment is responsible for leading a team of individuals to provide MercyOne payer credentialing and enrollment oversight, initial payer contract credentialing load, ongoing routine payer credentialing updates and audits. Responsibilities include coordination and process improvement of MercyOne payer credentialing efforts including collection, analysis, submission and auditing for facility, ancillary, and practitioner delegated and non-delegated payer credentialing. Responsible for guidance and education of payer credentialing requirements to MercyOne and communication of credentialing related reimbursement issues with payer to management and other departments including Admissions, Patient Accounts, HIM and Finance.

As a partner for transformation and in collaboration with the executive leadership across the organization, the Manager of Payer Credentialing and Enrollment serves as the principal driver for implementing strategic process improvement objectives and a change champion for integration of the payer credentialing and enrollment team including creation and execution of payer credentialing and enrollment policies and procedures that ultimately reflects performance in quality and financial measures.

ESSENTIAL FUNCTIONS

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

• Provide payer credentialing and enrollment oversight for MercyOne including project management for collection and submission of all facility, ancillary, and practitioner delegated and non-delegated payer credentialing and enrollment.

• Delivers internal consultative services related to Trinity Health and MercyOne RHM’s strategic goals to improve operational performance. Develops appropriate action plans as necessary and actively supports RHMs until performance is achieved.

• Directs and leads the activities of the Payer Credentialing and Enrollment team. Mentors, coaches and leads staff by providing performance assessment and feedback and advising on professional development and quality performance.

• Directs the operational and financial activities of payer credentialing and enrollment function.

• Facilitate responsibilities and frames the implementation of strategies, policies, procedures to be operationally effective to achieve desired performance.

• Demonstrates leadership, collaboration, critical thinking, and teamwork when facilitating operational decisions and resolving issues. Demonstrates leadership competencies of team building, vision creation, and influence. Incorporates change with leadership strategies through building a compelling vision, understanding the perspectives of the stakeholders, identification for tactics to elicit commitment and address resistance.

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

• Collaborates with health care executives in creating the organizational mission, vision and goals. Provides vision and strategic support and directs the integration of the payer credentialing and enrollment team.

• Improves the quality and effectiveness of the regional ministry's overall health care initiatives by providing leadership and operational direction over the payer credentialing and enrollment team.

• Serves as an expert to communicate payer credentialing and enrollment issues at the system and regional levels of the organization.

• Develops resource utilization strategies to improve organizational performance. Strategies reflect the changing societal and health care environments and the economic climate.

LEADERSHIP COMPETENCIES

As a MercyOne Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below:

Mission Statement: We, MercyOne Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.

• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.

• Safety : We embrace a culture that prevents harm and nurtures a healing, safe environment for all.

• Justice: We foster right relationships to promote the common good, including sustainability of Earth.

• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

• Integrity: We are faithful to those we say we are.

MINIMUM QUALIFICATIONS

• Must possess a comprehensive knowledge of payer credentialing and enrollment through equivalent combination of education and experience.

• Bachelor degree required.

• Clinicians (e.g., Nurse, Pharmacist) must have current credentials/licensure in good standing in their respective profession.

• At least seven (7) years of work experience consisting of leadership roles included but not limited to experience with payer credentialing and enrollment at a multi-hospital system including acute and ambulatory care venues.

• Highly developed verbal and written communication, persuasion and negotiation skills in order to effectively identify and coordinate services, assess organizational development opportunities, facilitate improvements, and present advisory, persuasive and authoritative recommendations to all levels of management and team members.

• Proven record of accomplishment of effectively consulting with/coaching team members in performance improvement initiatives in large/complex organizations.

• Exceptional leadership, management and facilitation skills. Demonstrated ability to skillfully counsel, collaborate and negotiate; inspire and build confidence in others; create alliances; obtain support and respect from diverse groups and foster an understanding and commitment to the ministry. Ability to adapt style and approach to match the needs of varying teams, individuals and situations. Knowledge and experience leading and managing complex organizational change and performance improvement.

• Advanced analytical, evaluative and problem-solving skills to serve in an advisory role in inspiring and initiating new ideas, determining strategies in the absence of guidelines, fostering innovative approaches to situations/processes/issues.

• Demonstrated proficiency and expertise to identify, evaluate and articulate operational opportunities and risks, business needs/gaps, and understand customer/stakeholder interests.

• Demonstrated experience in leading teams, transformational change, including knowledge and use of change leadership models, process redesign, plan implementation and accountability for execution. Ability to coach, mentor and provide guidance to lower level colleagues.

• Advanced business management skills to develop new or enhance existing operational and system strategies, policies and programs. Executive project management skills to lead strategic initiatives, identify and prioritize business needs, provide effective solutions and manage the necessary resources to accomplish goals and objectives.

• Must possess excellent verbal and written communications skills, presentation skills, advanced analytical skills, be well organized and maintain a highly professional manner and appearance.

• Strong interpersonal, consultative and relationship building skills in order to initiate and develop productive collaborative partnership with all levels of leadership across the organization and RHM external partners. Ability to effectively influence results, garner support and tactfully manage complex relationships within and across the organization as well as with external partners. Extremely high level of diplomacy and tact are required. Ability to read the subtle nuances of situation and react/plan accordingly.

• Must be comfortable operating in a collaborative, shared leadership environment.

• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

• Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

• Must be able to travel to the various MercyOne and Trinity Health sites as needed.

• Must possess the ability to comply with Trinity Health policies and procedures.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran