Senior Enrollment Specialist
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Job Description
Senior enrollment specialist managing provider enrollment and recredentialing for Beth Israel Lahey Health’s performance network. Maintaining health plan applications, databases, and credentialing status.
Responsibilities:
- Complete enrollment and health plan recredentialing applications under the direction of the Manager, Provider Enrollment
- Maintain the physician database and serve as a resource to providers, practice staff, BIDCO staff, and health plan representatives
- Facilitate timely enrollment of new providers and existing providers in newly contracted health plans
- Compile confidential data and accurate health plan application packets
- Review returned applications for accuracy and completeness before submission
- Perform provider recredentialing every two years and track applications through completion
- Input and maintain enrollment information and ongoing changes in the provider database
- Communicate with health plans, clinicians, and practice staff regarding provider participation and status
- Develop reporting mechanisms to keep providers and administrators informed of health plan status
- Investigate and resolve enrollment problems affecting billing and reimbursement
- Assist with applications for new group entities joining BIDCO and coordinate required documentation
- Coordinate with local community hospitals regarding hospital privileges and relevant documents
- Facilitate the delegated credentialing process with affiliated Professional Staff Affairs offices
Requirements:
- High School diploma or GED required
- Bachelor's degree preferred
- 1-3 years related work experience required
- Provider Enrollment experience strongly preferred
- Advanced skills with Microsoft applications, including Outlook, Word, Excel, PowerPoint or Access, and other web-based applications
- Ability to produce complex documents, perform analysis, and maintain databases
- Knowledge of Medicare, Medicaid, health plan credentialing, recredentialing and enrollment processes preferred
- Knowledge of licensure requirements and regulations of relevant medical boards preferred
- Ability to communicate complex information in English in written and verbal formats
- Ability to make moderately complex decisions and recommendations
- Ability to analyze and solve varied problems
- Ability to work independently within general guidelines and seek assistance when needed
- Ability to work collaboratively in small teams
- Ability to provide high-level customer service and staff training
- Ability to sustain concentrated effort for up to 4 hours without a break
- Ability to work sedentarily, including constant sitting and keyboard use, with frequent fine manipulation
- Must be vaccinated against influenza as a condition of employment
Benefits:
- Influenza vaccination required as a condition of employment
- Potential additional compensation through shift differentials, call pay, premium pay, and overtime pay, as applicable
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