Provider Enrollment Specialist

Location: Westwood, MA
Job ID: 167266-1A
Date Posted: Apr 22, 2021
Category: Specialist

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Job Description

Welcome To

Welcome to Beth Israel Lahey Health Behavioral Services. Our team delivers quality care to clients and families in more than 30 communities throughout the North Shore, Merrimack Valley and Greater Boston. Our mission is to provide personal, compassionate, state-of-the-art, integrated behavioral healthcare that makes a difference in the lives of the people and communities we serve. Our services include mental health counseling, addiction treatment, and family and school-based services.

 

About the Job

Under the direction of the Supervisors, the Provider Enrollment Specialist is responsible for completing, submitting, tracking enrollment and health plan re-credentialing applications of BILHPN providers. Maintains physician database and acts as a resource to providers, practice staff, BILHPN staff and health plan provider representatives concerning health care plan participation and status. Demonstrates competency in all aspects of the enrollment process and their assigned provider participation with over 25 affiliated health plans/ products, including Medicare and Medicaid.

 

Responsibilities:

  • Facilitates timely enrollment of new providers in health plans and existing providers in newly contracted health care plans including compilation of confidential data. Maintains knowledge of NCQA standards and health plan enrollment and credentialing guidelines (including Medicare and Medicaid). (essential)
  • Compiles accurate health plan application packets for the many different Members of BILHPN, keeping abreast of the numerous changes in application and licensure documentation. Reviews returned applications for accuracy and completeness prior to submission to the health plans. (essential)
  • Performs re-credentialing of BILHPN providers every 2 years so that providers may continue to bill for services rendered. Coordinates with departments to distribute re-credentialing applications and reminders, tracking all providers to completion within anticipated target dates. (essential)
  • Inputs enrollment information into the provider database at time of initial enrollment, and for any ongoing changes. Maintains accuracy and completeness of provider database. (essential)
  • Communicates directly with health plans, clinicians and BILHPN practice staff. Develops and implements reporting mechanisms to keep providers and administrators apprised of providers' health care plan status, working with them to ensure completion of enrollment with health plans within anticipated target date. (essential)
  • Develops and maintains excellent working relationships with both provider practices and health plan contacts regarding provider enrollment statuses. Investigates and resolves enrollment problems with health plans that are impeding proper billing and reimbursement. (essential)
  • Assist with the onboarding process for new group entities coming into BILHPN. Ensure that proper documents are obtained from the groups, coordinate with local community hospitals to determine hospital privileges and obtain relevant documents, review pre-BILHPN plan status and coordinate with management the timing of new entities into BILHPN. (essential)
  • Develops and builds strong collaborative relationships with the Medical Staff Affairs or Professional Staff Affairs offices to ensure proper malpractice face sheet, hospital privileges and other important credentialing files for providers are entered in system and aligned with payors requirements (essential).

Qualifications:

  • High School diploma or GED required.
  • 1-3 years related work experience required.

      Scheduled Hours

      Full time, 40 hours per week (Mon - Fri)

      About Us

      Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.

      Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.