Medicare Provider Enrollment Manager (HH & H)

WPS Health Solutions; Charleston (SC); Remote; USD 85,000 - 110,000; Full time

Job summary

A leading health insurance provider is seeking a Medicare Provider Enrollment Manager in South Carolina. This role involves managing daily operations, leading teams, and ensuring compliance with Medicare regulations. Ideal candidates have a Bachelor's degree and extensive Medicare experience. This position offers competitive salary and options for remote work.

Benefits

Performance bonus

401(k) matching

Health insurance from day 1

Flexible work options

Qualifications

• 5+ years of experience with Medicare Fee-for-Service provider enrollment operations.
• 3+ years of management or supervisory experience in Medicare operations.
• Extensive knowledge of healthcare credentialing and payer enrollment processes.

Responsibilities

• Manage daily enrollment operations and guide teams.
• Oversee provider enrollment processes.
• Analyze enrollment data to track performance metrics.

Skills

Medicare knowledge

Leadership capabilities

Analytical skills

Communication skills

Organizational skills

Education

Bachelor's Degree in Business or Healthcare Administration

Tools

FISS

MCS

PECOS

Job description

Overview

Role Snapshot Our Medicare Provider Enrollment Manager (HH & H - Home Health and Hospice) will lead supervisory and technical teams with responsibility for overseeing daily operations and functions related to provider enrollment. The role is responsible for managing and streamlining processes and implementing best practices to enhance the efficiency and effectiveness of the enrollment function while ensuring performance accountability. The Provider Enrollment Manager is accountable for managing, coaching, training, recognizing, and evaluating associates to foster a productive team environment. As part of the Provider Enrollment Leadership team, the manager will focus on workflow management, action planning, and departmental initiatives.

Salary

85,000 ~ 110,000. The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, experience and may fall outside of this range.

Work Location

We are open to remote work in the following approved states: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin.

Responsibilities

• Possess experience working with Medicare specifically in the Home Health and Hospice space.
• Manage and direct daily enrollment operations by providing guidance, coaching, and performance management to ensure accurate and timely completion of all aspects of the enrollment process.
• Organize, oversee, and manage all aspects of provider enrollment processes.
• Analyze enrollment data to track performance metrics and proactively identify trends.
• Maintain and ensure strict adherence to all internal and external regulatory requirements for credentialing and re-credentialing processes while staying abreast of enrollment requirements and industry best practices.
• Support and guide project inventory levels, ensuring production levels are maintained to meet goals and internal controls are maintained and followed.
• Oversee security responsibilities to ensure protection of company resources and data while ensuring privacy and confidentiality of Medicare data and employee information.
• Prepare and provide detailed management reports related to performance, staffing, budget, training, and resource needs.

Minimum Qualifications

• Bachelor\'s Degree in Business Administration, Healthcare Administration OR related field OR equivalent combination of education and experience.
• 5 or more years of experience with Medicare Fee-for-Service provider enrollment operations.
• 3 or more years of management, supervisory, or team lead experience in Medicare Part A, Part B, or Home Health and Hospice operations.
• Extensive knowledge of healthcare credentialing and payer enrollment processes, including state and federal regulations.
• Excellent verbal and written communication skills with the ability to effectively explain complex information.
• Strong analytical, problem-solving, and organizational skills with the ability to manage multiple processes simultaneously and meet strict deadlines.
• Demonstrated leadership and team-building capabilities.
• Ability to identify, prioritize and drive work efforts that result in more efficient operations through innovation or process improvement.
• Ability to work in a complex, rapidly evolving environment with multiple internal and external stakeholders.

Preferred Qualifications

• CMS knowledge of the Home Health and Hospice program.
• Experience processing Home Health and Hospice PE applications
• MAC contractor experience with FISS, MCS and PECOS systems.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection
• Please review Remote Worker FAQs for additional information

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
• Review additional benefits: https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS\'s culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organizations regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

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The position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.