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Specialist Managed Care Provider Enrollment
Burlington, MassachusettsOrganization Facility: Lahey Hospital and Medical Center Category: Payer Relations Job ID: JR3091 Date posted: 01/30/2023
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Work Shift:Day (United States of America)Position Summary: Responsible for preparing and submitting provider enrollment and re-enrollment applications to insurance plans for all Lahey providers, and for accurately using the databases and other technologies needed to do this work. Professionally communicates both verbally and in written work regarding provider enrollment.
Spec. Managed Care Provider Enrollment
Position Summary: Responsible for preparing and submitting provider enrollment and re-enrollment applications to insurance plans for all Lahey providers, and for accurately using the databases and other technologies needed to do this work. Professionally communicates both verbally and in written work regarding provider enrollment.
Essential Duties & Responsibilities including but not limited to:
- Prepares paper and electronic provider enrollment and re-enrollment applications. Works with physician/provider to assure timely completion of applications and return of applications to Provider Enrollment Department for submission.
- Accurately compiles applications and appropriate supporting documents obtained from physician/provider, ECHO database and submits applications through various written and electronic methods to insurance plans.
- Contacts insurance plans and verifies provider's enrollment, obtains provider numbers and effective dates.
- Enters pertinent provider information into an electronic databases in an accurate and timely way.
- Provides Patient Financial Services with appropriate data for billing purposes.
- Addresses questions from Lahey management and physicians/providers regarding enrollment into insurance plans, and researches answers to questions needed to enroll providers into insurance plans.
- Authors and sends correspondence to insurance plans to maintain current provider information including practice and billing addresses, panel status, resignations.
- Assists with review of insurance plan database outputs to assure accuracy of data about Lahey Clinc providers. Follows up with insurance plans to verify updates and changes have been made and are reflected accurately in all directories.
- Performs clerical functions as necessary to maintain provider files.
- Incorporates Lahey Health System Guiding Principles, Mission Statement and Goals into daily activities.
- Complies with all Lahey Health System Policies.
- Complies with behavioral expectations of the department and Lahey Health System.
- Maintains courteous and effective interactions with colleagues and patients.
- Demonstrates an understanding of the job description, performance expectations, and competency assessment.
- Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
- Participates in departmental and/or interdepartmental quality improvement activities.
- Participates in and successfully completes Mandatory Education.
- Performs all other duties as needed or directed to meet the needs of the department.
Education: High school diploma or equivalent
Licensure, Certification, Registration: N/A
Skills, Knowledge & Abilities: Excellent computer skills, outstanding attention to detail and to accuracy, familiarity and experience with inputting and extracting data from spreadsheets and windows-based databases, ability to adhere to specific time-frames and to reprioritize work independently as well as with direction. Excellent ability to communicate details verbally, and to write clearly and concisely. Excellent ability to collaborate with colleagues.
Experience: 2 years experience working within a healthcare facility or health insurance plan credentialing or provider enrollment department. Significant experience with Google G-Suite, Microsoft Word and Excel mandatory. Significant customer service experience.