Provider Enrolment Representative

Provider Enrolment Representative

Job Location: Charlestown, MA 02109

Duration: 06+ Months

Client: BMCHP2831

Qualifications:

Experience: 2 or more years business experience in a managed care or healthcare setting is required. Certification or Conditions of Employment: Pre-employment background check Competencies, Skills, and Attributes: Ability to work as a team member, to manage multiple tasks, to be flexible, and to work independently and possess excellent organizational and problem solving skills. Ability to accurately enter, proof, submit data and to identify inaccurate data and process to resolution. Demonstrated competence using Microsoft Office products especially Word, Excel, Outlook, Access, PowerPoint. Experience or knowledge of ONYX, FACETS and/or similar provider data and/or claims processing system. Effective communication skills (verbal and written).

Working Conditions and Physical Effort: Regular and reliable attendance is an essential function of the position. Ability to work OT during peak periods. Work is normally performed in a typical interior/office work environment. No or very limited physical effort required. No or very limited exposure to physical risk.

Responsibilities:

Responsible for accurate set up of provider records in order to assure proper payment for providers. Handles all implementation steps to enroll providers in the Plan to ensure timely access for members and accurate payment for providers. Key Functions/Responsibilities:

Manages the interaction with providers and office managers to ensure that all necessary information is collected and analyzed so providers can be credentialed and loaded in the system accurately according to department standards. Enters the provider data once the data are validated for accuracy so that providers are paid correctly from the beginning of their affiliation with the Plan.

Acquires and demonstrates a thorough knowledge of the unique arrangements and ensures the Plan enrols providers with those arrangements.

Independently initiates oversight of existing provider record problems. Identifies system problems with provider set up and facilitates resolution so that provider payments are accurate.

Coordinates set up and hand off of provider records to Credentialing Department. Completes provider data input and assures data forms are completed per BMCHP requirements.

Reviews submitted application and supporting documentation to ensure the data captured through the enrolment process is in compliance with NCQA, applicable state requirements.

Follows established contracting process to ensure the smooth implementation of the provider contracts. Tracks, maintains and communicates information pertaining to the status of contracts in accordance with the established contracting process.

Researches, facilitates and assists with resolution of interdepartmental issues related to enrolment as identified by providers and internal BMCHP staff.

Maintains the integrity of Provider Data in Onyx. Provides assistance with ongoing quality initiatives related to improved data processing and workflows.

Provides system analysis support as needed to ensure operational compliance with Plan provider and database rules.

Develops basic reports in Onyx in order to provide and communicate information.

Supervision Exercised: None Supervision Received: Direct supervision is received weekly.