Specialist, Provider Enrollment

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Full time

Medical Staff Office

300 Ocean Avenue – Revere

The Provider Enrollment Specialist is responsible for supporting the provider enrollment processes of the Medical Staff Office under the direction of the Credentialing Manager. This position will lead the coordination of the provider enrollment onboarding of new providers at the time of hire, while on staff and at the time of departure. It will execute and facilitate tasks related by gathering and disseminating information to the appropriate administrative stakeholders to ensure a timely start of clinical duties for new providers and facilitates tasks to ensure appropriate actions are performed at the time of provider departure.

The Provider Enrollment Specialist verifies that data obtained from the provider and internal and external parties is documented in the computer software systems, provides information to requesting departments, hospitals, and agencies. Works with Credentialing Manager to develop and implement new systems and procedures as necessary. Ability to communicate effectively with all levels of staff including Administrative and Medical Directors as well as senior administration in the performance of his or her duties.

Attention to detail, strong technical and organizational skills, good communication, and interpersonal skills are requirements of this position.

• Works with the Credentialing Manager in coordinating the onboarding of new Health Center billable providers prior to their hire and the offboarding of Health Center billable providers at the time of departure. Must understand the process to enroll a provider with the payers and the requirements of each payer.
• Gathers and disseminates information to appropriate administrative stakeholders to ensure a timely start of clinical duties for new billable providers and facilitates tasks to ensure appropriate actions are performed at the time of provider departure.
• Verifies that data obtained from the provider as well as internal and external parties, is accurate. Documents in computer systems, and provides information requested from internal and external sources. Interacts with resources including external health resources, IT, team members, and various inter and intradepartmental staff to obtain valid, reliable data as indicated.
• Works closely with Credentialing Manager to coordinate the submission of enrollment documents to the payers in conjunction with the submission of the BMC application.
• Will outreach to the payers on a weekly basis to check the status of applications/linking requests previously submitted. Once the provider is approved, data should be entered into the matrix and updated in the provider enrollment electronic file.
• Work closely with BMC’s Provider Enrollment Department to coordinate provider enrollment/linking for the BMC-employed providers.
• For new providers, complete the CAQH online application. This consists of entering all education, training, 10-year work history, 10-year malpractice history, etc., and uploading licensure into CAQH.
• Ongoing will be responsible for maintaining CAQH Profiles for approximately 375+ providers, including BMC Radiologists.
• This consists of reviewing online…