Company Overview

Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building.

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Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare’s greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve.

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Overview

The Manager, Implementation is responsible for the management and execution of effective day to day medical provider enrollments, workflows, staff training and necessary department activities enterprise wide. This includes communicating key risks and opportunities to management, continuous process improvements, aligned to business strategy and all applicable compliance guidelines and standards.

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Duties and Responsibilities:

• Responsible for managing all aspects of the provider enrollment department(s), including but not limited to; enrollment applications completion, workflow, and staffing;
• Serve as the internal point person on enrollment issues and resolutions;
• Ensure that all provider enrollment processes are completed in an accurate, timely manner and all existing group/physician credentials are up to date;
• Establish procedure/training for individual staff members or entire departments.;
• Monitor timeliness and effectiveness of enrollment services activities, implement processes to identify any risks and communicate and update leadership;
• Research markets and determine payer requirements as well as manage onboarding of new provider, locations and regions;
• Compile and prepare a variety of reports for management, clients and Compliance to analyze trends and make recommendations;
• Interpret complex notices from regulatory entities, such as CMS and State Medicaid entities, to ensure that work processes are compliant;
• Provide credentialing management, and enrollment team with regular communications regarding the status of all aspects of enrollment work process, procedures and training;
• Document processes and requirements and establish operational policies and procedures and ensure accurate implementation;
• Develop relationships with the provider enrollment team and document needs and organizational priorities;
• Develop relationship with Clinical Managers, Entity Owners, Nurse Providers and provide status of enrollment process on a regular basis;
• Enhance and standardize our work-flow processes throughout the enrollment cycle to assist in achieving consistency and success;
• Ensure that all provider enrollment processes are completed in an accurate, timely manner and all existing group/physician credentials are up to date;
• Develop and manage policies and procedures on an annual basis, including management of updates and development of new policies, as needed for enrollment services;
• Prepare and represent the department during internal and external audits, including preparation of records and input on the rebuttal of any findings;
• Prepare recommendations for management on process flow, improvements, and system modifications;
• Develop training for new department staff and related department staff and corporate overviews as necessary to ensure the appropriate level of knowledge to support the department's objectives and the accuracy of member data;
• Participate in internal and external audit activities including onsite audits and reporting requests;
• Ensure reconciliation of enrollment data and oversee reconciliation process with staff;
• Monitor accuracy, timeliness, ensure compliance with Legal and Compliance departments; and
• Prepare various oversight and monitoring reports for the department on a daily, weekly, monthly or quarterly basis as needed for quality, production and backlog monitoring.
• Maintain compliance with Inovalon’s policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;
• Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Company;
• Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function; and 
• We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

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Job Requirements:

• Minimum 5 years of progressive experience with provider enrollment within the healthcare industry managed care organization;
• Prior supervisory or lead experience in a production environment specializing in performing Medicare or Medicaid enrollment processing;
• Demonstrated enrollment expertise in a fast-paced environment with competing priorities;
• Experience with Enrollment / Credentialing software platform;
• Ability to lead team building, work prioritization, day-to-day staff oversight and problem solving, and coaching;
• Excellent interpersonal skills with emphasis on ability to effectively communicate both verbally and in writing;
• Ability to document work processes or changes required to ensure compliance and act on regulatory or corporate compliance within deadlines;
• Strong Microsoft Outlook including Excel;
• Self-motivated and continually seeking ways to optimize enrollment services and processes; and
• Credentialing certification (CPCS or CPMSM) a plus.

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Education:

• Bachelor’s degree and or relevant experience required.

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Physical Demands and Work Environment:

• Sedentary work (i.e. sitting for long periods of time);
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
• Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;
• Subject to inside environmental conditions; and
• Travel for this position will include less than 5% locally usually for training purposes.

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The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge/skills, experience, business needs, geographical location, and internal equity. At Inovalon, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.

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Base Compensation Range

$90,600—$120,000 USD

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Studies have shown that women and people of color are less likely to apply for jobs unless they believe they meet every one of the qualifications listed in a job description. If you don’t meet every qualification listed but are excited about our mission and the work described, we encourage you to apply regardless. Inovalon is most interested in finding the best candidate for the job and you may be just the right person for this or other roles.

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By embracing diversity, equity and inclusion we enhance our work environment and drive business success. Inovalon strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

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Inovalon is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.

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The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship.

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To review the legal requirements, including all labor law posters, please visit this link