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Wellforce HHPHO Provider Enrollment Coord in Woburn, Massachusetts

Position Summary: Reporting to the Director of Provider Services, the Hallmark Health Physician Hospital Organization (HHPHO) Provider Enrollment and Directory Coordinator is responsible for managing all aspects of the provider enrollment process and ensuring the accuracy of the HHPHO Provider Directory. The Coordinator works closely with the Hallmark Health Independent Provider Association (HHIPA), MelroseWakefield Healthcare (MWHC) medical staff office, Tufts Medical Center Community Care (TMC CC) and provider practices to ensure all required provider documentation is received, accurate and collected in a timely manner. The Coordinator will manage new IPA provider applications process and updates on any existing IPA membership changes ensuring such information is prepared for review by the HHIPA Board of Directors. The Coordinator works with New England Quality Care Alliance (NEQCA)/Wellforce and individual health plans to ensure providers are enrolled in health plan contract, track contract enrollment status and/or troubleshoots issues as needed. The Coordinator is also responsible for maintaining all documentation and the accuracy of the Provider Directory including additions, terminations or resignations and any demographic/other changes. In addition this individual will manage the communication of IPA provider changes to the PHO and NEQCA/Wellforce as needed (e.g., monthly PHO Newsletter updates, PHO POD meetings, e-mail communications, etc.). This role will have the opportunity to play an active part in enhancing existing processes and policies as needed to continuously improve the accuracy of provider information for the PHO.

EDUCATION:

High School graduate or equivalent with Associates degree or equivalent education required, a bachelor’s degree preferred.

EXPERIENCE:

3-5 years of related experience in a healthcare setting preferred. Prior experience in managed care a plus. Knowledge of medical terminology helpful.

SKILLS/ABILITIES:

Excellent computer skills required including all Microsoft applications. Knowledge of Microsoft Access. Strong communication skills. Ability to organize and establish work priorities. Ability to interface with all levels of staff. Ability to work independently.

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