Beth Israel Deaconess Medical Center Senior Enrollment Specialist in Boston, Massachusetts
Senior Enrollment Specialist
Job LocationBoston, Massachusetts
Req ID 21338BR
Department Description: Beth Israel Deaconess Care Organization (BIDCO) is a value-based physician and hospital network and Accountable Care Organization (ACO) that partners with providers to improve quality of care while effectively managing medical expenses. With its corporate office located in Westwood, Mass., BIDCO’s mission is to move health care forward by engaging providers in their communities to achieve success in a value-based delivery system.
BIDCO is committed to creating innovative, industry-leading best practices in the clinical, administrative, and financial aspects of health care. To deliver value to patients, commercial payors, and government, BIDCO leverages the shared skills of 2,600 primary care physicians (PCPs) and specialists and numerous community hospitals, including Anna Jaques Hospital, Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Plymouth, the Cambridge Health Alliance, Lawrence General Hospital, and New England Baptist Hospital. BIDCO has a tertiary affiliation with Beth Israel Deaconess Medical Center.Job Location: Boston, MAReq ID: 21338BRJob Summary: Under the direction of the Manager, Provider Enrollment completes enrollment and health plan recredentialing applications. Maintains physician database and acts as a resource to providers, practice staff, BIDCO staff and health plan provider representatives concerning health care plan participation and status. Demonstrates competency in all aspects of the enrollment process and their assigned provider participation with over 25 affiliated health plans/ products, including Medicare and Medicaid.
Facilitates timely enrollment of new providers in health plans and existing providers in newly contracted health care plans including compilation of confidential data . Maintains knowledge of NCQA standards and health plan enrollment and credentialing guidelines (including Medicare and Medicaid).
Compiles accurate health plan application packets for the many different Members of BIDCO, keeping abreast of the numerous changes in application and licensure documentation. Reviews returned applications for accuracy and completeness prior to submission to the health plans.
Performs recredentialing of BIDCO providers every 2 years so that providers may continue to bill for services rendered. Coordinates with departments to distribute recredentialing applications and reminders, tracking all providers to completion within anticipated target dates.
Inputs enrollment information into the provider database at time of initial enrollment, and for any ongoing changes. Maintains accuracy and completeness of provider database in accordance with uniform nomenclature.
Communicates directly with health plans, clinicians and BIDCO practice staff. Develops and implements reporting mechanisms to keep providers and administrators apprised of providers' health care plan status, working with them to ensure completion of enrollment with health plans within anticipated target date.
High School diploma or GED required. Bachelor's degree preferred.
1-3 years related work experience required.
Provider Enrollment experience is strongly preferred.
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
- Knowledge of Medicare, Medicaid and health plan credentialing, recredentialing and enrollment process; licensure requirements and regulations of various agencies such as the board of Registration in Medicine, American Board of Medical Specialties and Individual Specialty Boards preferred normally acquired through related work experience.
Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally