PROVIDER ENROLLMENT AND FINANCIAL ASSISTANCE SERVICES MANAGER

PROVIDER ENROLLMENT AND FINANCIAL ASSISTANCE SERVICES MANAGER

Posting Number: SRGV6765
Number of Vacancies: 1
Location: Harlingen, Texas
Department: School of Medicine / Clinical Affairs
FLSA: Exempt

Scope of Job:
Responsible for coordinating and managing UT Health Rio Grande Valley (UT Health RGV) provider enrollment and re-enrollment process in a timely and compliant manner with all contracted commercial and government payers. Also, responsible for overseeing patient assistance services, which includes securing payment solutions for uninsured and underinsured patients to enable them to meet their financial obligations to UT Health RGV.

Description of Duties:

• Responsible for managing the daily operations of the provider enrollment and patient financial assistance services teams and their functions.
• Responsible for all enrollment activities including initiation and review of applications, ongoing monitoring and processing of provider payer enrollments, re-enrollments, and demographic updates with contracted payers. Ensures submission of provider applications and provider updates are done accurately and timely.
• Oversees team performing pre-liminary financial screening to determine eligibility for government, state, local, and other assistance programs, including securing free medications by utilizing manufacturer patient assistance programs (PAPs).
• Serves as a liaison between insurance payers and UT Health RGV to resolve any billing issues related to provider enrollment and promote optimal reimbursement.
• Guides and trains Financial Counselors in working with patients/patient’s families to educate them on payment options and out of pocket amounts due and financial assistance programs when applicable.
• Collaborates in development and execution of policies and procedures supporting a delegated credentialing/enrollment process.
• Responsible for reviewing and handling escalations from provider enrollment team and follows up with resolution on open applications with provider or payers that have been in process more than 60 days of submission.
• Monitors, manages, and actively follows up on active large self-pay accounts to ensure solutions and/or solution modifications are in place to optimize ultimate payment for UT Health RGV.
• Maintains communication with internal/external customers, ensuring accuracy of provider applications, and creating efficiency for the onboarding process.
• Oversees and ensures that enrollment activities meet federal, state, and department guidelines and the maintenance of provider data in online payer systems is kept up to date to ensure timely renewals.
• Develops and evaluates policies and procedures to establish guidelines for financial counselors and provider enrollment specialists to ensure processes are compliant and efficient.
• Responsible for understanding and remaining current with the ever-changing application and enrollment processes, qualifying criteria, and other processes for the manufacturers’ patient-assistance programs (PAPs). Addresses PAPs issues as needed.
• Maintains knowledge of local, state, and federal Medicare/Medicaid assistance programs/requirements.
• Assesses enrollment workload of team and distributes accordingly and may assist with workload as necessary.
• Assists and prepares for government/state/insurance payer audits, including site audits, as applicable.
• Ensures that Financial Counselors inform patients of their financial liability, collect for services, and/or make payment arrangements with the patients as needed.
• Conducts training and quality assurance with Financial Counselors and Provider Enrollment Specialists to ensure they understand all aspects of their job duties and are performing them consistently to the standard level set by UT Health RGV.
• Provides reports for distribution to internal and external customers regarding provider status in the enrollment process, approved providers, and their projected start dates (or end dates). Ensures accurate and concurrent updates and tracking for each provider reflect the history of a provider’s enrollment status.
• Approves financial assistance applications for charity care and ensures they comply with established guidelines. Refers applicable charity accounts per guidelines to Revenue Cycle leadership for final approval.
• Engages in proactive communications with drug and device manufacturers about their assistance programs so as to expand recovery savings for UT Health RGV.
• Performs other duties as assigned.

Supervision Received:
General supervision from assigned supervisor.

Supervision Given:
Direct supervision of assigned staff.

Required Education:
Bachelor’s degree in Business, Healthcare Administration, or related field from an accredited university.

Preferred Education:
None.

Licenses/Certifications:
None.

Required Experience:
Four (4) years of related experience working in managed care enrollment environment with multiple provider specialties and provider types including supervisory experience in provider enrollment or related area. Knowledge of state and federal regulations for provider practices/clinics or other ambulatory healthcare settings. Working knowledge of provider enrollment structure, requirements, standards, and processes. Must have knowledge and experience of public assistance programs and required forms. Demonstrates knowledge of Medicare, Medicaid, and Managed Care payer guidelines and criteria for reimbursement. Experience in lieu of education may be substituted on a 2-for-1 basis.

Preferred Experience:
Related experience obtained in a clinic or ambulatory setting.

Equipment:
Use of standard office equipment.



Working Conditions:
Needs to be able to successfully perform all required duties. Office/Healthcare environment; some travel and weekend work is required. Exerting up to 20 pounds of force frequently, and/or a negligible amount of force constantly to move objects. UTRGV is a distributed institution which requires presence at multiple locations throughout the Rio Grande Valley.

Other:
Exceptional planning and organizational skills. Excellent communication, interpersonal, and critical thinking skills. Exhibits sound judgement and must be able to prioritize and meet deadline on an ongoing basis to ensure timely completion according to process requirements. Must be detail oriented, possess basic mathematical skills, and have strong analytical and problem-solving skills to resolve financial issues. Must demonstrate a positive demeanor and be professional in both appearance and approach.

Physical Capabilities: N/A
Employment Category: Full-Time
Minimum Salary: Commensurate with Experience
Posted Salary: Commensurate with Experience
Position Available Date: 06/20/2023
Grant Funded Position: No
If Yes, Provide Grant Expiration Date:

EEO Statement:
It is the policy of The University of Texas Rio Grande Valley to promote and ensure equal employment opportunities for all individuals without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or protected veteran status. In accordance with the requirements of Title VII of the Civil Rights Act of 1964, the Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, as amended, our University is committed to comply with all government requirements and ensures non-discrimination in its education programs and activities, including employment. We encourage women, minorities and differently abled persons to apply for employment positions of interest.

Special Instructions to Applicants:
Dear Applicant,

Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following:

Date of Birth
Social Security Number
Gender
Ethnicity/Race

Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission.

If you have any questions, please do not hesitate to contact us at (956)665-8880 and/or careers@utrgv.edu.



Additional Information:
UTRGV is a distributed location institution and working location is subject to change based on need.

All UTRGV employees are required to have a criminal background check (CBC). Incomplete applications will not be considered.

Substitutions to the above requirements must have prior approval from the Chief Human Resources Officer.

To apply, visit https://careers.utrgv.edu/postings/38657 jeid-c35535b0bee2ab4e83f3f1db3bb555b5