Sr. Enrollment Specialist, BILH Performance Network | Hybrid/Remote Schedule

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the direction of the Manager, Provider Enrollment completes enrollment and health plan recredentialing applications. Maintains physician database and acts as a resource to providers, practice staff, BIDCO 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.

Job Description:

Primary Responsibilities:

1. 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)

2. Compiles accurate health plan application packets for the many different Members of BIDCO, 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)

3. Performs recredentialing of BIDCO providers every 2 years so that providers may continue to bill for services rendered. Coordinates with departments to distribute recredentialing applications and reminders, tracking all providers to completion within anticipated target dates. (essential)

4. Inputs enrollment information into the provider database at time of initial enrollment, and for any ongoing changes. Maintains accuracy and completeness of provider database in accordance with uniform nomenclature. (essential)

5. Communicates directly with health plans, clinicians and BIDCO 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)

6. 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)

7. Assist Administrator in the processing of applications with the health plans for new group entities coming into BIDCO. Ensure that proper documents are obtained from the groups, coordinate with local community hospitals to determine hospital privileges and obtain relevant documents, review pre-BIDCO plan status and coordinate with management the timing of new entities into BIDCO. (essential)

8. Facilitate delegated credentialing process in coordination with affiliated Professional Staff Affairs offices. (essential)

Required Qualifications:
1. High School diploma or GED required. Bachelor's degree preferred.

2. 1-3 years related work experience required.

3. Provider Enrollment experience is strongly preferred.

4. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web- based applications. May produce complex documents, perform analysis and maintain databases.

Preferred Qualifications:

1. Knowledge of Medicare, Medicaid and health plan credentialing, recredentialing and enrollment process; licensure requirements and regulations of various agencies such as the board of Registration in Medicine, American Board of Medical Specialties and Individual Specialty Boards preferred normally acquired through related work experience.

Competencies:

1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.

2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.

3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.

4. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.

5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.

6. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.

7. Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.

8. Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

Social/Environmental Requirements:

1. Work requires periods of close attention to work with out interruption. Concentrated effort of up to 4 hours without break may be required.

2. Work requires constant response to changing circumstances and using new information to adjust approach and to quickly respond to new needs.

3. No substantial exposure to adverse environmental conditions

4. Health Care Status: NHCW: No patient contact.- Health Care Worker Status may vary by department

Sensory Requirements:

Close work (paperwork, visual examination), Monitor Use, Visual monotony, Visual clarity feet, Conversation, Monitoring Equipment, Telephone, Background Noise.

Physical Requirements:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally

This job requires constant sitting, Keyboard use,frequent Fine Manipulation using one hand.There may be occasional walking, standing, Pushing/Pulling using both hands.

Pay Range:

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