Kimberly Poland

Manager Provider Enrollment @Presbyterian Healthcare Services

US

Keep reprised of regulations regarding the provider enrollment process.• Oversee the department budget.• Create and maintain department policies and procedures.• Work closely with the Billing and Follow up teams to research the denials related to provider enrollment.• Work with the Contracting department on ensuring we are meeting our contractual requirements with health plan payers. This includes redlining payer contracts.• Work with entities like the State of New Mexico, Novitas, and multiple provider licensing agencies, as well as multiple health plans on ensuring they are meeting the needs of our delegated payer contracts.• Perform payer audits annually as required by delegated contracting. Provide monthly, quarterly and annual provider rosters. Presbyterian Health Plan provider files, complaints and monthly required regulatory verifications reports on providers to share with all delegated payers as required. Supply any required documentation requested for delegated payer NCQA audits.• Review all new and renewed payer contracts for accurate enrollment related requirements based on system and other abilities.• Work with Epic upstream to create standardization in processes in enrollment for correct claims processing downstream.• Manage all the actions identified by the Provider Data Work Group and ensure they are carried out, by providing specialized knowledge and professional opinion on Provider Data Work Group matters, offering a link to other PHS applications, reporting, and content resources and experts and help resolve Provider Work Group-specific issues. Also provide a perspective need for effective decision making and provide specialized knowledge within the Provider Data Work Group.• Oversee the PMG Marketing provider directory in accordance with rules established by PHP and PMG Medical Directors.• Create provider bios for new providers is coming into practice. This includes both online and print cards for waiting rooms.

Tiffin University

MSCJ, Criminal Justice - Criminal Behavior

Bellevue University

Bachelor of Applied Science (B.A.Sc.), Criminal Justice Administration