Director, Claims Enrollment and Implementation - Experian Health (This role is remote from anywhere in the U.S.!)

Company Description

At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is the centerpiece of making this happen. Our aspiration is to bring people together who are driven by purpose and want to make a difference.  We strive to have a diverse group of people and minds who are:

• OPEN: Have a growth mindset and collaborate often with others to make things happen
• NIMBLE:  Always embracing change and pushing the envelope on innovative ways to solve problems
• EFFECTIVE:  Accountable to themselves and to others

Job Description

The Director, Claims Enrollment and Implementation is responsible for the day to day operations, of the ClaimSource Enrollment Department.

*ClaimSource is a best in KLAS product!   https://www.experian.com/blogs/healthcare/2023/02/experian-health-ranked-1-in-best-in-klas-for-2023/

Manages a team of enrollment coordinators, responsible for processing new hospital and physician practice enrollments, as well as focused on post live support of ClaimSource customers.

• Monitors Salesforce queue for new enrollment case
• Communicates in a timely manner with customers
• Provides forms and or instructions needed for enrollment
• Assures timely follow-up with payers/vendor partners on requested enrollments
• Provides status reports via Salesforce ticket
• • Assuring that standard processes are followed during the implementations and that implementations are completed in a timely manner
  • Assists staff with escalations and implementation issues
  • Reviews new implementations and participates in Intro Calls for new customers
• Identifies risks to the enrollment project and works to resolve
• Assures new implementation information is properly imported into the enrollment tool
• Verify all Tax ID/NPI combination supplied by provider and confirm total number of enrollments with provider
• Identify payers that require enrollment and review enrollment requirements, taking into account connection route to payer client
• Provide enrollment requirements for all payers to customers at the onset of implementation
• Use confirmed list of claims payers requiring enrollment and forwarding enrollment forms and/or instructions to the provider via email (preferred) or other trackable means if necessary (i.e. FedEx, UPS, etc) along with an enrollment task list detailing all pertinent information (i.e. Tax ID/NPI combinations, list of payers, etc.)
• Provide timely enrollment status reports to customer throughout the implementation
• Conduct enrollment status calls with customers  
  • Participates in calls to provide enrollment process information, status updates, handles escalation requests
• Ongoing maintenance and further development of PayerSource/EnrollSource, our internal and customer facing enrollment tool

Qualifications

• 10+ years' healthcare experience
• 5+ years extensive healthcare enrollment knowledge and EDI expertise
• 5+ years' directly managing a team of EDI enrollment coordinators
• Client focused
• Project management experience
• Highly detailed, organized, proactive, dedicated
• Passion for achieving initiatives
  • Resourceful, able to execute on those initiatives
  • Able to engage and gain collaboration with stakeholders

Additional Information

Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.
EOE including Disability/Veterans.

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