Provider Enrollment Associate

Job title: Provider Enrollment Associate
Shift Times: 8am - 4:30pm
Incumbent is accountable for a contribution to the revenue of the clients Health System through the maintenance of providers with government and commercial health plans.

Under direction of the Manager, Provider Enrollment/Business Intelligence and the Supervisor of Provider Enrollment, the position is responsible for a variety of duties related to the initial enrollment, re-enrollment and termination, of participation for Baystate Health System physicians and other professional providers.

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 Billing Office, Baycare Health Partners and Corporate Risk Management. Externally, those include payor credentialing departments; Centers for Medicare and Medicaid, applicable managed care organizations, and other state and federal agencies.

The incumbent will be primarily responsible for provider re-enrollment, and termination activities and may support the Provider Enrollment Specialist with initial enrollment work. The incumbent will be responsible to gather and compile renewed licensure, board and insurance information and maintain this information in provider enrollment files, databases and with appropriate payors. The incumbent must review provider information for accuracy and completeness and follow-up with providers to fill in any gaps in the information. Working with the Provider Enrollment Specialists the incumbent will assist in follow-up work with the plans in a manner that assures minimal or no delays in ascertaining the status of applications.

Incumbent must maintain orderly, complete and up to date files on each individual provider. 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 outstanding provider enrollment issues, as well as maintaining provider enrollment reports and other records of provider enrollment activity.

The incumbent must be able to work independent, but have the ability to judge when issues should be brought to a specialist or management for resolution.

INDS