Specialist, Provider Enrollment

East Boston Neighborhood Health Center Corporation•Revere, MA

5d•$31 - $48

About The Position

As one of the largest community health centers in the country, NeighborHealth is proud to serve the greater Boston area with a strong commitment to the health and well-being of our patients and communities. Whether you're a nurse or physician providing direct care, a manager leading dedicated teams, or part of the essential support staff who keep our operations running smoothly — every role at NeighborHealth is vital. Together, we’re advancing medicine and delivering the best care experience for our patients and community! The Provider Enrollment Specialist is responsible for supporting the provider enrollment processes of the Medical Staff Office under the direction of the Credentialing Manager. This position will lead the coordination of the provider enrollment onboarding of new providers at the time of hire, while on staff and at the time of departure. Will execute and facilitate tasks related by gathering and disseminating information to the appropriate administrative stakeholders to ensure a timely start of clinical duties for new providers and facilitates tasks to ensure appropriate actions are performed at the time of provider departure. The Provider Enrollment Specialist verifies that data obtained from the provider and internal and external parties is documented in the computer software systems, provides information to requesting departments, hospitals, and agencies. Works with Credentialing Manager to develop and implement new systems and procedures as necessary. Ability to communicate effectively with all levels of staff including Administrative and Medical Directors as well as senior administration in the performance of his or her duties. Attention to detail, strong technical and organizational skills, good communication, and interpersonal skills are requirements of this position.

Requirements

Associates, Bachelor’s degree, or equivalent experience in health care preferred.
One to three year’s experience working in a Medical Staff Office, Credentialing or Managed Care in a hospital, managed care insurance, or community health center environment.
Demonstrated computer skills, human relations, and effective communication and report preparation skills.
Good interpersonal and excellent organizational skills.
Must be able to work with detailed confidential material

Nice To Haves

experience in Workday is desired.

Responsibilities

Works with the Credentialing Manager in coordinating the onboarding of new Health Center billable providers prior to their hire and the offboarding of Health Center billable providers at the time of departure.
Must understand the process to enroll a provider with the payers and the requirements of each payer.
Gathers and disseminates information to appropriate administrative stakeholders to ensure a timely start of clinical duties for new billable providers and facilitates tasks to ensure appropriate actions are performed at the time of provider departure.
Verifies that data obtained from the provider as well as internal and external parties, is accurate.
Documents in computer systems, and provides information requested from internal and external sources.
Interacts with resources including external health resources, IT, team members, and various inter and intradepartmental staff to obtain valid, reliable data as indicated.
Works closely with Credentialing Manager to coordinate the submission of enrollment documents to the payers in conjunction with the submission of the BMC application.
Will outreach to the payers on a weekly basis to check the status of applications/linking requests previously submitted.
Once the provider is approved, data should be entered into the matrix and updated in the provider enrollment electronic file.
Work closely with BMC’s Provider Enrollment Department to coordinate provider enrollment/linking for the BMC-employed providers.
For new providers, complete the CAQH online application. This consists of entering all education, training, 10-year work history, 10-year malpractice history, etc., and uploading licensure into CAQH.
Ongoing will be responsible for maintaining CAQH Profiles for approximately 375+ providers, including BMC Radiologists. This consists of reviewing online Profiles for each provider, making necessary changes/updates to the data, and uploading licensure upon renewals, as well as re-attesting that all provider information is accurate and up to date every 90 days to avoid delays with payer credentialing and recredentialing.
Answers phone calls and other inquiries regarding Medical Staff Office information, referring to the Credentialing Manager and/or Director any issues beyond the scope of this position.
Proficient in various information systems and software applications, i.e., Workday, Excel, Microsoft Word, DocuSign, and MSOW (BMC credentialing database).
Performs periodic audits in accordance with established protocols.
Contact the payers or BMC in conjunction with responsibilities for maintaining an up-to-date database.
Prepare enrollment packets for providers in advance.
Maintain detailed records of enrollment activities and correspondence in the provider enrollment electronic file.
QI Projects for internal and external requests.
Reads, understands, and complies with all Standards of Conduct, JCAHO policies, and all laws related to position responsibilities and employment at NeighborHealth
Upholds procedures and systems to safeguard the confidentiality of all patient and employee information.
Upholds safety policies, practices, and procedures, including safety, fire safety, electrical safety, proper body mechanics and material handling, office/ergonomic safety, and other employee safety measures.