Provider Enrollment Analyst
About The Position
At NorthBay Health, the Provider Enrollment Analyst is responsible for all Medical Staff and Allied Health Practitioner (AHP) health 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. Serves as a resource related to the National Committee for Quality Assurance (NCQA).
Requirements
- 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.
- Demonstrates NorthBay Health’s True North Values: Nurture Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence.
- Works independently utilizing a high level of initiative, judgement and critical thinking skills.
Nice To Haves
- Serves as a resource related to the National Committee for Quality Assurance (NCQA).
Responsibilities
- 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.
Benefits
- 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
- market-based compensation review and increases subject to approval and organizational performance
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
