Provider Enrollment Coordinator

General Summary/ Overview:

Under the direction of the Supervisor, Revenue Cycle Enrollment, the Provider Enrollment Coordinator will be responsible for the insurance carrier enrollment and re-enrollment of clinical staff and ancillary providers, the maintenance of these providers in the Medical Staff Office system and in CAQH, and the dissemination of the provider information to both internal and external customers.

The Provider Enrollment Coordinator must possess a comprehensive knowledge of the MGB payer policies, contract language and procedures to prepare and disseminate provider enrollment applications to the MGB payers. Payer enrollment applications must be executed accurately to ensure the correct set up with health plans. The Provider Enrollment Coordinator is required to demonstrate effective communication skills and the ability to work as a team player with various levels of staff both internally and externally.

Principal Duties and Responsibilities:

Prepare paperwork, deliver to provider, then collect all enrollment materials required to enroll or re-enroll a provider with the insurance carriers.

Insure the integrity of and carries out the enrollment process in accordance with the Unit policies.

Acquire a CAQH ID for the provider, complete CAQH information, and update the appropriate enrollment system with the CAQH ID information for the provider.

Submit all enrollment paperwork to the carriers, including but not limited to name, location, and practice guidelines.

If available by the payer enter all enrollment information into the appropriate online portal or system and adhere to all appropriate rules and regulations as established.

Submit re-enrollment/revalidation on a two-year birthday cycle to the carriers or as defined by the payers processes.

Track status of a carrier enrollments, update provider enrollment systems, and notify the appropriate EPIC Team, when necessary, as approval is obtained.

Work with the other Revenue Cycle Operations (RCO) departments, PCPO, the Central Credentialing Office on any enrollment related issues that arise with the provider billing.

Serve as a resource to providers, appointments coordinators, and PBO regarding the enrollment process.

Gather or establish usernames and passwords for the NPI systems, NPPES, for physicians and store the information within the appropriate enrollment systems.

Additional projects and or duties as assigned.

Qualifications:

Bachelor's degree preferred. In lieu of degree, will consider individual with directly related experience in provider enrollment and/or credentialing in health care setting.

CPCS certification a plus.

Requires 1 - 3 years experience in a healthcare setting.

Knowledge of managed care or provider credentialing is preferred.

Knowledge of billing processes preferred.

Skills/Abilities/Competencies:

A successful candidate will possess the following qualities:

Strong analytical and problem-solving skills.

Strong written and verbal communication skills.

Self-motivated, able to learn quickly and be flexible.

Strong computer skills and knowledge of Microsoft Office (Word/Excel).

Prefer knowledge of provider enrollment systems, but not required.

Must be a self-starter with the ability to work both independently and as part of a team.

The ability to multi-task and prioritize work accordingly.

The ability to efficiently adapt to and flourish within a time-sensitive enterprise environment.

Supervisory Responsibilities:

The individual will have no direct reports.

Fiscal Responsibility:

The individual will have no direct fiscal responsibility

Working Conditions:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

This position is a combination of remote and on-site as needed.

Hospital work environment working conditions include possible exposure to diseases or infections and may require safety gear (PPE (Personal Protective Equipment)) such as gloves and mask.

Normal office working conditions. The noise level in the work environment is quiet to moderate.

While performing the duties of this job, the employee is frequently required to sit, talk; or hear; use hands to finger; handle; or feel; reach with hands and arms. The employee is occasionally required to stand, walk; and stoop; kneel; or crouch. The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 20 pounds.

Specific vision abilities required by this job include close vision, distance vision and depth perception.