Lahey Health Provider Enrollment Specialist in Westwood, Massachusetts
Welcome to the Beth Israel Lahey Health Performance Network (BILHPN). BILHPN is a clinically integrated network of physicians, clinicians, and hospitals committed to providing high-quality, cost-effective care to the patients and communities they serve, while effectively managing medical expense. Leveraging best practices in population health management and data analytics, BILHPN improves care quality and patient health outcomes across Beth Israel Lahey Health through population health initiatives. BILHPN brings together the expertise of more than 4,500 providers across Eastern Massachusetts who share a common goal to achieve success in a value-based delivery system.
About the Job
The Provider Enrollment Specialist is responsible for completing, submitting, tracking e nrollment and health plan re-credentialing applications of BILHPN providers. Maintains physician database and acts as a resource to providers, practice staff, BILHPN staff and health plan provider representatives concerning health care plan participation and status. Demonstrates competency in all aspects of the enrollment process and their assigned provider participation with over 25 affiliated health plans/ products, including Medicare and Medicaid.
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 BILHPN, 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 re-credentialing of BILHPN providers every 2 years so that providers may continue to bill for services rendered. Coordinates with departments to distribute re-credentialing 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. (essential)
Communicates directly with health plans, clinicians and BILHPN 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 with the onboarding process for new group entities coming into BILHPN. Ensure that proper documents are obtained from the groups, coordinate with local community hospitals to determine hospital privileges and obtain relevant documents, review pre-BILHPN plan status and coordinate with management the timing of new entities into BILHPN. (essential)
Develops and builds strong collaborative relationships with the Medical Staff Affairs or Professional Staff Affairs offices to ensure proper malpractice face sheet, hospital privileges and other important credentialing files for providers are entered in system and aligned with payors requirements (essential).
High School diploma or GED required.
1-3 years related work experience required.
40 hours, Monday-Friday (Days)
Beth Israel Lahey Health is d edicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve. Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health. Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.
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