Manager, Government Enrollment and Physician Credentialing
Location: Irvine, CA
At Alliance HealthCare Services, our focus is on transforming the customer and patient experience. Vital to our success are the Corporate Team Members who collaborate with clinical, operational, and sales teams in the field. We focus on delivering improved processes, innovative new services, and business solutions that differentiate and advance our comprehensive clinical services—always with our patients’ and customers’ needs in mind.
The Manager of Government Enrollment and Physician Credentialing will supervise all aspects of Alliance Healthcare Services government healthcare provider enrollment and physician/physicist credentialing programs. The primary responsibility of the Manager of Government Enrollment and Physician Credentialing is to ensure that Alliance Healthcare Services is in 100% compliance with all Medicare and Medicaid regulations and timely filing requirements. The Team Member in this position is the guardian of the Alliance Healthcare Services active Medicare and Medicaid certifications with the responsibility for ensuring that there is never a time when Alliance Healthcare Services is in jeopardy of having any certification revoked or terminated. This is a corporate level task that requires the Manager of Government Enrollment and Physician Credentialing to work directly with all other Alliance Healthcare Services departments and divisions to provide the requisite information needed to complete initial and revalidation applications accurately and within the timeframe required by Medicare and Medicaid. In the event Medicare or Medicaid sends back a development request, the Manager of Government Enrollment and Physician Credentialing will ensure accurate and timely responses that include engaging the legal department to develop an appeal when Alliance Healthcare Services disputes the position Medicare or Medicaid is taking related to any particular regulation. This position supervises the Team Members who complete the Alliance Healthcare Services provider enrollment applications, revalidations and updates for governmental healthcare programs, including Medicare and Medicaid. The role is responsible for ensuring that all Alliance Healthcare Services independent diagnostic testing facilities (“IDTFs”) pass onsite inspections by Medicare and State Medicaid inspectors in order to remain compliant with the IDTF performance standards and other Medicare/Medicaid requirements. The Manager develops precise and rigorous training materials and training programs for newly hired team members. When there are significant changes to either the Medicare or Medicaid regulations or a change to the Alliance Healthcare Services ownership structure, the manager prepares training materials and specific training programs for all internal staff including the Manager’s direct reports, Business Development, Sales, and Operations on the issues and their impact to the IDTF site operations. The Manager of Government Enrollment and Physician Credentialing is the subject matter expert on Medicare and Medicaid regulation and acts in the capacity of being a resource to others in the company.
The Manager also has responsibility for the physician and physicist credentialing for all locations, retail, wholesale, RAD360 and Oncology. This positions manages all physician and physicist credentialing activities including policy development, oversight of the source verification qualifications and management of the credentialing committee to stay in compliance with the Joint Commission standards. On a monthly basis, the Manager will track upcoming license and insurance expirations to ensure all physicians and physicists remain eligible to perform services on behalf of Alliance. The Manager ensures all credentialing files are complete, accurate and available in order to comply with Joint Commission audits.
The Manager of Government Enrollment & Physician Credentialing is responsible for the implementation of the systems and processes necessary to support efficient and effective activities within the Government Enrollment and Physician Credentialing department. This includes developing and using tracking reports to monitor department and individual Team Member results to ensure key performance indicators are met each month.
Specific duties include, but are not limited to: