Sr. Enrollment Specialist

Primary Responsibilities:

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). (essential)

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. (essential)

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. (essential)

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. (essential)

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. (essential)

Develops and maintains excellent working relationships with both provider practices and health plan contacts regarding provider enrollment statuses. Investigates and resolves enrollment problems with health plans that are impeding proper billing and reimbursement. (essential)

Assist Administrator in the processing of applications with the health plans for new group entities coming into BIDCO. Ensure that proper documents are obtained from the groups, coordinate with local community hospitals to determine hospital privileges and obtain relevant documents, review pre-BIDCO plan status and coordinate with management the timing of new entities into BIDCO. (essential)

Facilitate delegated credentialing process in coordination with affiliated Professional Staff Affairs offices. (essential)

Required Qualifications:

Year of experience 3-7

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.

Preferred Qualifications:

1.      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.