Provider Enrollment Specialist

Overview

Provider Enrollment Specialist — Full-Time — Onsite

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. Will execute and facilitate tasks related to gathering and disseminating information to the appropriate administrative stakeholders to ensure a timely start of clinical duties for new providers and facilitate 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, and provides information to requesting departments, hospitals, and agencies.

• Work 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.

• Reads, understands, and complies with all Standards of Conduct, JCAHO policies, and all laws related to position responsibilities and employment at Neighbor Health
• Upholds procedures and systems to safeguard the confidentiality of all patient and employee information.
• Upholds safety policies, practices, and procedures, including safety, fire safety, electrical safety, proper body mechanics and material handling, office/ergonomic safety, and other employee safety measures.

Education: Associates, Bachelor’s degree, or equivalent experience in health care preferred.

Experience: One to three year’s experience working in a Medical Staff Office, Credentialing or Managed Care in a hospital, managed care insurance, or community health center environment. Demonstrated computer skills, human relations, and effective communication and report preparation skills.

Skills/Abilities: Good interpersonal and excellent organizational skills. Must be able to work with detailed confidential material; experience in Workday is desired.

Neighbor Health is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need…