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Clinical Practice Association Core Services Provider Enrollment is seeking a Provider Enrollment Manager  (Core Services Operations Manager) who will work under the direction of the Director of Provider Enrollment & Third Party Reimbursement, and will supervise the implementation, monitoring and refinement of established policies and procedures. This position will assist the Director in analyzing the financial and operational impact of third party insurer requirements, policies and procedures, state laws and regulations and coding protocols to the JHU Clinical Practice Association's billing operation. 

Serve as a secondary contact in absence of director to coordinate JHUSOM third party payer issues and problems with insurers, followed with appropriate resolutions. Assist director in coordinating billing regulatory concerns with the Senior Director, Revenue Operations; Senior Director, Contract Services; Senior Director, Office of Managed Care; Compliance Office and the Director of Information Systems. Extensive experience with PC based and mainframe programs, specifically spreadsheets, data base applications are essential. Position is responsible for all payors with the exception of Medicare.

Specific Duties & Responsibilities:

Procedural Knowledge:

• On a daily basis, provide professional consultation and assistance regarding industry standards, regulations, and payment operations, to department staff, Production Unit Managers, Associate Directors, Directors, and Senior Directors within the SOM and JHBP to improve  receivable collectability and staff efficiencies
• Provides day to day oversite for Enrollment & Reimbursement Coordinator staff
• Proactively research, interpret, and communicate complex Third Party Payer guidelines and specifications that impact accurate claims submission, payments ,and appeals that affect PBS operations and the filing and reimbursement of claims for numerous Production Billing Unit Specialties
• Attend meetings and in-services with Senior Management throughout the SOM and JHBP as assigned by Director of 3rd Party Reimbursement; also represent department in director's absence
• Initiate and hold meetings, onsite sessions, and conference calls with Third Party Payers, Production Unit Managers and staff for issue resolution and education
• Reviews and resolves provider enrollment related rejections daily.  Follows Provider Not Enrolled (MCOB7) Resolution Policy to enroll deactivated providers immediately
• Reviews Provider Enrollment Charge Edits timely to identify and enroll providers who need to be enrolled with RailRoad Medicare
• Reviews Provider Enrollment related Claim Edits timely to ensure providers with outstanding enrollment s are captured on the
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  Johns Hopkins University remains committed to its founding principle, that education for all students should be grounded in exploration and discovery. Hopkins students are challenged not just to learn but also to advance learning itself. Critical thinking, problem solving, creativity, and entrepreneurship are all encouraged and nourished in this unique educational environment. After more than 130 years, Johns Hopkins remains a world leader in both teaching and research. Faculty members and their research colleagues at the university's Applied Physics Laboratory have each year since 1979 won Johns Hopkins more federal research and development funding than any other university. The university has nine academic divisions and campuses throughout the Baltimore-Washington area. The Krieger School of Arts and Sciences, the Whiting School of Engineering, the School of Education and the Carey Business School are based at the Homewood campus in northern Baltimore. The schools of Medicine, Public Health, and Nursing share a campus in east Baltimore with The Johns Hopkins Hospital. The Peabody Institute, a leading professional school of music, is located on Mount Vernon Place in downtown Bal...timore. The Paul H. Nitze School of Advanced International Studies is located in Washington's Dupont Circle area.

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