Office Support Specialist I

Commonwealth of Massachusetts•Tewksbury, MA

13h•Onsite

About The Position

The Department of Public Health (DPH) at Tewksbury Hospital is looking for a Credentialing Office Support Specialist I to join its team. This role is responsible for overseeing provider enrollment and access within the Centers for Medicare & Medicaid Services (CMS) Provider Enrollment, Chain, and Ownership System (PECOS) after clinicians have been credentialed and granted medical staff privileges. The Credentialing Office Support Specialist coordinates federal and state provider enrollment activities to ensure compliance with CMS and MassHealth requirements.

Requirements

Ability to communicate effectively
Ability to multi-task and prioritize
Ability to assist customers of diverse backgrounds
Knowledge of software applications such as desktop publishing, project management, spreadsheets, and database management.
At least (A) two years of full-time, or equivalent part-time, experience in administrative work experience or (B) any equivalent combination of the required experience and the substitutions below:
Substitutions:
I. An Associate's or higher degree with a major in business administration, business management or public administration may be substituted for the required experience.
II. An Associate's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required experience.
Educational substitutions will only be permitted for a maximum of two years of the required experience.

Nice To Haves

Knowledge of the laws, rules, regulations, policies, procedures, specifications, standards and guidelines governing assigned agency or unit activities.
Knowledge of the types and uses of agency databases, documents and files.
Knowledge of state laws, procedures, and guidelines.

Responsibilities

Create and maintain individual provider enrollment accounts for Individual Provider Enrollment (CMS-855I) and Reassignment of Benefits (CMS-855R).
Set up provider access and ensure accurate enrollment in the CMS/PECOS system.
Enter and maintain provider demographics and practice location information.
Process reassignment of benefits to the appropriate group practice.
Upload and maintain all required credentialing and enrollment documentation.
Coordinate and obtain provider approval signatures on enrollment applications and supporting documents.
Collaborate with the Fiscal/Billing department to ensure accurate provider enrollment, reimbursement setup, and payer compliance.
Coordinate MassHealth enrollment for non-billing providers, including assisting with individual provider contracts for Ordering, Referring, and Prescribing (ORP) providers.
Monitor and ensure completion of required five-year revalidation for CMS and MassHealth provider enrollments to maintain active participation.
Track enrollment application status, respond to requests for additional information, and resolve issues with CMS, MassHealth, and Medicare Administrative Contractors (MACs).
Offboard departing clinicians by terminating or updating CMS and MassHealth enrollments, ending reassignment relationships, and removing applicable system access in accordance with organizational policies.
Maintain accurate provider enrollment records and ensure compliance with federal, state, payer, and organizational credentialing standards.
Assist with the coordination the DPH Practitioner’s Schedule for the Department of Medicine
Takes minutes at Committee meetings and other meetings assigned