Credentialing & Enrollment Coordinator, Medical Staff Office (40 hrs, Days)

POSITION SUMMARY:

Under the supervision of the Associate Director of Medical Staff Office & Provider Enrollment, is responsible for the timely credentialing for the payer enrollment of all new and existing BMC/Boston University Medical Group practitioners with third party payors. The job requires an individual with strong organizational skills, strong communication skills, and strong time management skills to keep a very large and complex system running efficiently.

Position: Credentialing & Enrollment Coordinator       

Department: Medical Staff Office

Schedule: 40 hours, Days

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Responsible for ensuring the timely enrollment of new providers and maintenance of existing providers with 3rd party payers and governmental payors including but not limited to Medicare and Medicaid.
• Responsible for performing follow up inquiries with payers to ensure timely provider enrollment.
• Responsible for the on-going maintenance of existing providers, including but not limited to the submission of maintenance forms to update personal and practice demographic data for providers, billing updates, CAQH re-attestations, and revalidations, et al.
• Accountable for submitting termination requests to all health plans in a timely manner.
• Responsible for inputting provider enrollment information into MSOW with flow to EPIC and other BMC or BUMG information systems; and distribution of information to designated department representatives, billing vendors and credentialing administrators.
• Adhere to BMC & BUMG policies and procedures as they relate to the provider enrollment process, established to assure payor and NCQA compliance.
• Promote and maintain a professional demeanor both personally and on behalf of BMC & BUMG, acting as a liaison to hospital departments, outside agencies, physicians, medical practice groups, 3rd party/governmental payors, etc.
• Must have proven ability and maturity to maintain sensitive and confidential information.
• Must have ability to identify problems in the credentialing and enrollment process with strong problem-solving skills needed to resolve any problem as they arise.
• Must be able to function independently and perform routine department procedures without supervision.

JOB REQUIREMENTS

EDUCATION:

Associates degree or equivalent experience. Bachelor’s degree preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

CPSC: Certified Provider Credentialing Specialist, preferred

EXPERIENCE:

Requires 3 years experience in a healthcare system, group practice, Medical Staff Office, credentials verification organization or health plan.  A bachelor’s degree in information systems or healthcare management or previous database administration experience may be substituted for the required experience.

Knowledge of provider credentialing and/or enrollment required

KNOWLEDGE AND SKILLS:

• Work requires basic knowledge of credentialing and enrollment procedures / requirements.
• Ability to work well with all levels of personnel to establish and maintain harmonious working relationships with providers, chiefs of service, department directors and administrative staff and outside agencies.
• Strong communication, time management and organizational skills required to keep a very large and complex system running efficiently.  Ability to prioritize duties and meet deadlines.
• Work requires ability to consolidate information from various sources.  Ability to identify problems in the credentialing and enrollment process and strong problem solving skills needed to resolve any problem as they arise.
• Proficiency with Microsoft Office applications (i.e. MS Word, Excel, Access, PowerPoint, Outlook) and web browsers.  Experience with CAQH system and third party insurance websites a plus.
• Skilled in basic computer programs, such as Word and Excel.  Experience with Microsoft Office.
• Promotes and maintains a professional demeanor both personally and for BMC & the FPF.
• Able to function independently and perform routine department procedures without supervision.
• Must have proven ability to maintain sensitive and confidential information.

Equal Opportunity Employer/Disabled/Veterans