Enrollment Specialist- Managed Care Provider Enrollment

BILH Team Enrollment Specialist

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

Job Title: Government Payer Enrollment Specialist

Under the direction of the Manager, Provider Enrollment and Reporting, the government payer Enrollment Specialist is responsible for the enrollment of both individual providers and groups/locations with non-commercial payers (Medicare, Medicaid).

Job Description:

The provider enrollment process ensures that the appropriate provider enrollment numbers are obtained for both individual providers and groups/locations enabling the organization to bill provider charges in a timely manner and ensure clinicians have the ability to order, refer, and prescribe as necessary. This includes initiating the enrollment process from notification that a new individual providers or groups/locations will be added to the network and collaborating with multi-disciplinary on-boarding group and the practitioner to complete the application process.

The position also includes responsibility for ensuring that the re-verification process and any interim or re-credentialing activities required by government payers occurs to ensure continuous, uninterrupted participation status for all both individual providers and groups/locations. This position maintains up to date and thorough knowledge of non-commercial payer enrollment obligations at the State and Federal level.

1. Completes the government payer enrollment process for all new individual providers and groups/locations within established timeframes.

2. Obtains information needed for government payer application process from individual providers as well as leveraging information on file, already available within Medical Staff Administration and/or network development staff.

3. Completes maintenance updates and re-verification/re-validation for all both individual providers and groups/locations within established timeframes.

4. Maintains and updates data on both individual providers and groups/locations including, but not limited to name changes, office location and demographic changes, linking practitioners to new groups, TINs.

5. Responsible for populating and updating various databases, internal and external, to accurately reflect non-commercial (government) payer participation and related data.

6. Prior to each Credentials Committee meeting or approval of applicants by the Credentials Committee; submits enrollment applications to appropriate state(s) Medicare/Medicaid programs.

7. Prior to opening or acquisition of groups/locations submits enrollment applications to appropriate state(s) Medicare/Medicaid programs.

Education:

Bachelor's Degree or equivalent education and experience.

Experience:

Minimum of 2-3 years experience in non-commercial payer enrollment.

Provider enrollment technical proficiency, effective and professional communication skills.

Licensure:

CPCS or PESC Certification preferred but not required

Pay Range:

$21.28 - $32.55

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled