United States onlyMass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
General Summary/ Overview:Under the direction of the Supervisor, Revenue Cycle Enrollment, the Provider Enrollment Coordinator will be responsible for the insurance carrier enrollment and re-enrollment of clinical staff and ancillary providers, the maintenance of these providers in the Medical Staff Office system and in CAQH, and the dissemination of the provider information to both internal and external customers.
The Provider Enrollment Coordinator must possess a comprehensive knowledge of the MGB payer policies, contract language and procedures to prepare and disseminate provider enrollment applications to the MGB payers. Payer enrollment applications must be executed accurately to ensure the correct set up with health plans. The Provider Enrollment Coordinator is required to demonstrate effective communication skills and the ability to work as a team player with various levels of staff both internally and externally.
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 Revenue Cycle Operations (RCO) departments, PCPO, the Central Credentialing 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
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 is preferred.
§Knowledge of billing processes preferred.
Skills/Abilities/Competencies:
A successful candidate will possess the following qualities:
- Strong analytical and problem-solving skills.
- Strong written and verbal communication skills.
- Self-motivated, able to learn quickly and be flexible.
- Strong computer skills and knowledge of Microsoft Office (Word/Excel).
- Prefer knowledge of provider enrollment systems, but not required.
- Must be a self-starter with the ability to work both independently and as part of a team.
- The ability to multi-task and prioritize work accordingly.
- The ability to efficiently adapt to and flourish within a time-sensitive enterprise environment.
Supervisory Responsibilities:
The individual will have no direct reports.
Fiscal Responsibility:
The individual will have no direct fiscal responsibility
Additional Job Details (if applicable)
Remote Type
RemoteWork Location
399 Revolution DriveScheduled Weekly Hours
40Employee Type
RegularWork Shift
Day (United States of America)EEO Statement:
Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
JM and US only
