Provider Enrollment Analyst

Job Description

At NorthBay Health, the Provider Enrollment analyst is responsible for all Medical Staff and Allied Health Practitioner (AHP) heal plan credentialing and recredentialing with government and commercial health plans. The position is responsible for enrollment, credentialing and termination of NorthBay physicians/providers with NorthBay's contracted health plan partners. This position maintains rosters and functionality that support a compliant provider enrollment process. Additional role responsibilities include compiling and distributing periodic reports, both within the department and throughout the organization as well as investigating and resolving provider enrollment issues. Servies as a resource related to the National Committee for Quality Assurance (NCQA).

PRIMARY JOB DUTIES

• Responsible for all enrollment functions, credentialing and termination of providers and select contracted specialists.
• Serves as a resource in credentialing standards for NCQA, CMS, Medi-Cal, medical group affiliates and health plans.
• Monitors current regulations and enrollment guidelines for payers of all current and future healthcare services.
• Proficient in PECOS, PAVE, CAQH, Better Doctors, MD-Staff and other credentialing and enrollment software and websites, and other tools required to enroll, credential and terminate providers.
• Coordinates assigned enrollment activities and tracks progress toward established timelines.
• Provides enrollment information and support to Administration (Department Directors, Managers, Supervisors), medical staff and hospital personnel in all activities related to provider health plan credentialing requirements.
• Responsible for maintaining databases with Medical Staff that support the health plan enrollment functions.
• Collaborates with Revenue Cycle to correct any payment deficiencies due to health plan enrollment.
• Track, document, communicate, and escalate provider enrollment issues timely and appropriately to department leadership or other stakeholders.
• Cross trains with other department Analysts to assist with various system maintenance, updates, etc.
• Enhances professional growth and development through educational programs or seminars.
• Maintain effective working partnerships internally and externally to support provider enrollment efforts.
• Works independently utilizing a high level of initiative, judgement and critical thinking skills.

This is not a remote position. Hybrid position requires 2 days days on-site, 3 days remote.

Hours of Work: Non-exempt. Normally works eight-hour day. Hours will vary according to work demands and project requirements.

Qualifications

REQUIRED:

• Minimum 5 years of experience in a corporate business setting, preferably in a health care setting.
• Advanced computer skills to include: Microsoft Windows and Office suite, Access, MD Staff, Tableau and other on-line enrollment systems.
• Must possess teaching ability and demonstrate the ability to efficiently collaborate with others.
• Capable of communicating effectively at all levels of the organization. Ability to work on multiple projects simultaneously and manage deadlines.
• Must be highly organized with the ability to set priorities, work independently and be an effective team member.
• Ability to integrate information from multiple sources into an automated process to effectively manage provider health plan enrollment.

PREFERRED:

• NCQA health plan accreditation training preferred

About Us

Interpersonal Skills and Values

Demonstrates NorthBay Health's True North Values: Nurture Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence. These values guide behavior, accountability, teamwork, and commitment to high-quality patient care.

Why NorthBay Health

NorthBay Health is an independent, nonprofit health system serving the Napa, Solano, and Yolo County regions. We are expanding access to care across our communities through two acute-care hospitals, including a Level II Trauma Center and a Level III NICU maternity unit, along with a cancer center, urgent care locations, and a growing network of primary and specialty care clinics.

We provide advanced services in cardiovascular care, neuroscience, orthopedics, surgery, and outpatient specialties. NorthBay Health is nationally recognized for quality care, including Magnet with Distinction designation for nursing and multiple U.S. News and World Report high performing recognitions.

We are committed to being the trusted healthcare partner of choice and offer an environment where employees can grow, contribute meaningfully, and support the health of our communities.

NorthBay Health Benefits Options

NorthBay Health offers a comprehensive benefits package based on established eligibility requirements. Benefits may include medical, dental, and vision insurance, life, disability, and long-term care coverage, paid time off including vacation, sick leave, holidays, and bereavement, a 403(b) retirement plan with employer match, education reimbursement for eligible roles, professional development and training programs, Employee Assistance Program, wellness programs, recognition programs, shift differentials, and market-based compensation review and increases subject to approval and organizational performance.

Compensation Structure

NorthBay Health uses a structured compensation framework. Staff-level positions use a step-based system (Steps 1-5) based on years of directly related experience, with Step 5 representing 20 or more years of experience in the role. Manager level and above positions are paid a fixed annual base salary and are eligible for a variable incentive compensation plan. Physician compensation is structured based on specialty and role requirements.

Remote Work Disclosure

NorthBay Health is primarily an onsite organization due to the nature of healthcare. Some roles may allow hybrid or remote work based on business needs.

Remote work is not supported in Washington, Ohio, Wyoming, North Dakota, Puerto Rico, the U.S. Virgin Islands, or outside of the United States.

Notice to Recruitment Agencies

NorthBay Health utilizes a managed service provider (MSP) for agency partnerships and is not currently engaging external recruiting firms outside of established agreements. We do not accept unsolicited resumes or third-party candidate submissions. Please do not contact NorthBay Health employees, leaders, physicians, or hiring managers regarding recruitment or job postings.

More Information

Visit NorthBay Health Careers for recruitment FAQs and additional information.