Provider Enrollment Specialist R31535

Req#: R31535

Category(s): Finance, Practice Finance

Full Time / Part Time: Full-Time

Shift: First

Summary:

Incumbent is accountable for a contribution to the revenue of Baystate Health System through the effective enrollment of employed providers into government and commercial health plans. Under direction of the Manager, Medical Staff Services and Provider Enrollment, the position is responsible for a wide variety of duties related to the initial enrollment, re-enrollment and termination, of participation for BMERF, BAPO and BVS physicians and other professional providers (e.g. nurse practitioners, certified midwives, physician assistants, licensed social workers and certified nurse specialists). Incumbent assures optimum efficiency and effectiveness of provider enrollment policies and procedures.

The incumbent must maintain good working relationships and communication channels with a number of internal and external parties. Internally, those include individual providers, practice managers, Medical Staff Office, Physician Recruitment Office, Physician Billing Office, Baycare Health Partners, Corporate Risk Management and Information Systems. Externally, those include payor credentialing departments; Centers for Medicare and Medicaid, applicable managed care organizations, and other state and federal agencies.

Upon initiation of enrollment, re-enrollment, and termination activities, the incumbent must gather, compile, analyze, and evaluate provider specific information based on the requirements of each managed care or government plan. Consequently, the incumbent must remain informed of those requirements, standards and/or procedures as they change from time to time. All changes must be incorporated into the policies and procedures established by Provider Enrollment.

The incumbent must review provider information for accuracy and completeness and follow-up with providers to fill in any gaps in the information. The application must coincide with the credentialing committee meeting schedules of each plan. In addition, follow-up work with the plan must be conducted in a manner that assures minimal or no delays in ascertaining the status of applications.

The incumbent is responsible for initiating accurate billing profiles in the IDX physician billing system. The incumbent must interact and collaborate with representatives from the Physician Billing Office (PBO) to address reimbursement related issues relative to Provider Enrollment. Incumbent must maintain orderly, complete and up to date files on each individual provider.

In the event of a data discrepancy, the files serve as a source of official record of information submitted to plans, and help to assure maximum efficiency in processing initial and re-credentialing applications.

The incumbent must adhere to established procedures and controls to provide follow-up and reporting on all outstanding provider enrollment issues. The incumbent is responsible for recommending and implementing performance improvement initiatives that assure the most appropriate procedures and controls are in place relating to the identification and resolution of all outstanding provider enrollment issues, as well as compiling, maintaining, and distributing provider enrollment reports and other records of provider enrollment activity.

The incumbent will monitor the effect of such initiatives and report findings to management as required. The incumbent is responsible for maintaining the provider enrollment computer software system in coordination with the software vender, and identifying and resolving system issues either independently or with assistance from Information Systems and/or the vendor. The incumbent must be able to work independent from management, but have the ability to judge when issues should be brought to management for resolution. The position serves in a consulting role to both providers and practice management and is responsible for assisting and guiding providers and practice management through the enrollment and credentialing process.

Job Responsibilities: 

1) General Provider Enrollment activities

2) Coordinates the submission of Provider Enrollment applications

3) Provides adequate follow-up on applications in process and on outstanding enrollment issues and information

4) Records management

5) Special projects

6) Individual and/or team objectives from previous review cycle

Required Work Experience: 

1) 3-5 years experience in related job experience in physician enrollment or physician related field required

Preferred Work Experience: 

1) None Listed

Skills and Competencies: 

1) HIghly proficient in current Microsoft environment, relational databases, spreadsheets, word processing, electronic scheduling and e-mail systems

2)  Mastery of analytical and problem solving skills

3)  Ability to organize workload and manage multiple projects within deadlines

4)  Demonstrates service excellence, detail orientation, superb organizational skills and follow-through, and analytical ability/skills

5)  Demonstrated ability to maintain professional demeanor and presentation under all circumstances

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Associate of Arts (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

Apply Now