Lead Credentialing Enrollment Coordinator

POSITION SUMMARY:

Under the supervision of the Associate Director of MSO & Provider Enrollment, is responsible for the timely enrollment of all new and existing BMC Affiliated Physician with some coverage of BUMG practitioners with third party payors. Requests and obtains provider data. Maintains provider information in existing computer software systems.

Requires an individual with strong organizational skills, detail oriented with an ability to work in varied and busy atmosphere and an individual who can independently organize and prioritize the workload to support the goals of the Boston Medical Center Health System. Maturity, discretion and an ability to maintain confidentiality are of utmost importance.

Position:Lead Credentialing Enrollment Coordinator

Department: Provider Enrollment Office

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

Based on assignment, principal duties will be as follows:

Lead Responsibilities:

• Manages enrollment coordinators' day-to-day work-flows, distributing workload in fair and equitable manner
• Covers work gaps during staffing shortage to help meet department enrollment policy requirements
• Implements the payer enrollment processes, providing guidance, support, and training to department members and identifies areas for process improvement
• Reviews coordinators' work to ensure completeness and quality, providing ongoing coaching and training as needed
• Plans out workload for new provider enrollment and enrollment maintenance
• Ensures Medicare and Medicaid Revalidations are submitted by staff
• Assess billing inquiries pertaining to enrollment, managing workflow with team
• Manages onboarding and training of new staff

In the Enrollment Director's absence, the Team Lead assumes the responsibilities of the department director.

Keep current regarding any changes in managed care and other third party payor requirements for provider enrollment.

Follow BMC, BMCAP, and BMCAP policies and procedures as they relate to the provider enrollment process. Adhere to strict guidelines as established to assure payor and NCQA compliance.

Acts as liaison to BMCAP and hospital departments, outside agencies, physicians, medical practice groups, 3rd party/governmental payers etc.

Enrollment Responsibilities

Responsible for ensuring timely enrollment of new providers with 3rd party payers; and the governmental payers including but not limited to Medicare and Medicaid. Performing follow up inquiries with payers as needed to complete provider enrollment.

Responsible for the on-going maintenance of existing active providers including but not limited to the submission of maintenance forms to update personal and practice demographic data, billing updates, et al.

Accountable for submitting termination requests to all health plans in a timely manner.

Reviewing billing issues presented to Provider Enrollment

Systems and Reporting:

• Accountable for overseeing and for directly updating provider data in the CAQH system, as necessary
• Responsible for inputting provider enrollment information into Apogee and EPIC system and other BMC, BMCAP, and BUMG information systems
• Distributes information to designated department representatives, billing vendors and credentialing administrators

• Produces the weekly enrollment reports for team members and departments
• Pulls rosters for insurance plans and BACO/ACO/insurance contracting needs

General Responsibilities

Consistently deliver exemplary customer service to both internal and external clients.

Participate in continuous improvement examining processes and automation techniques in order to make systems more efficient.

Prepare reports, complete surveys and questionnaires for Directors, departments, other agencies and institutions as required.

Perform other duties as assigned.

Utilizes hospital's Values as the basis for decision making and to facilitate the division's hospital mission.

Follows established hospital infection control and safety procedures.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

Associates degree or equivalent experience. Bachelor's degree preferred.

EXPERIENCE:

Requires 3 - 5 years of experience in a healthcare system, group practice, Medical Staff Office, credentials verification organization or health plan.

Advanced knowledge of provider enrollment required.

KNOWLEDGE AND SKILLS:

Work requires basic knowledge of credentialing and enrollment procedures / requirements.

Knowledge of basic office management procedures and of enrollment procedures and requirements.

Ability to work well with all levels of personnel to establish and maintain harmonious working relationships with providers, chiefs of service, department directors and administrative staff and outside agencies.

Strong communication, time management and organizational skills required to keep a very large and complex system running efficiently.

Work requires ability to consolidate information from various sources.

Ability to identify problems in the credentialing and enrollment process and strong problem solving skills needed to resolve any problem as they arise.

Ability to prioritize duties, meet deadlines Must have proven ability to maintain sensitive and confidential information.

Skilled in basic computer programs, such as Word and Excel. Experience with Microsoft Office.

Promotes and maintains a professional demeanor both personally and for BMC BMCAP & BUMG.

Able to function independently and perform routine department procedures without supervision.

Equal Opportunity Employer/Disabled/Veterans