Job Description

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Prepare paperwork, deliver to provider, then collect all enrollment materials required to enroll or re-enroll a provider with the insurance carriers.
Insure the integrity of and carries out the enrollment process in accordance with the Unit policies.
Acquire a CAQH ID for the provider, complete CAQH information, and update the appropriate enrollment system with the CAQH ID information for the provider.
Submit all enrollment paperwork to the carriers, including but not limited to name, location, and practice guidelines.
If available by the payer enter all enrollment information into the appropriate online portal or system and adhere to all appropriate rules and regulations as established.
Submit re-enrollment/revalidation on a two-year birthday cycle to the carriers or as defined by the payers processes.
Track status of a carrier enrollments, update provider enrollment systems, and notify the appropriate EPIC Team, when necessary, as approval is obtained
Work with the other Professional Billing Office (PBO) departments, PCPO, the Partners Central Verification Office on any enrollment related issues that arise with the provider billing
Serve as a resource to providers, appointments coordinators, and PBO regarding the enrollment process.
Gather or establish usernames and passwords for the NPI systems, NPPES, for physicians and store the information within the appropriate enrollment systems.
Additional projects and or duties as assigned.

QUALIFICATIONS

Bachelor’s degree preferred. In lieu of degree, will consider individual with directly related experience in provider enrollment and/or credentialing in health care setting.
CPCS certification a plus.
Requires 1 - 3 years experience in a healthcare setting.
Knowledge of managed care or provider credentialing required.
Knowledge of billing processes preferred. 

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED

Must have strong interpersonal skills and have the ability to work well with individuals at all levels within the institution.  Excellent oral and written communication skills will be needed. Strong computer skills are a must with knowledge of Microsoft Office (Word/Excel).  Prefer knowledge of provider enrollment systems, but not required.  Candidate must be a self-starter with the ability to work both independently and as a part of a team.