Open position

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Job Type:

Regular

Scheduled Hours:

40

Work Shift:

Day (United States of America)

Under the direction of the Enrollment supervisors, the Provider Enrollment Quality Data Analyst will work with BILHPN enterprise network level to maintains, create and monitors Enrollment rosters for the accuracy of the data within BILPN enrollment systems, and BILPN’s contracted health plans.

The Provider Enrollment Quality Data Analyst will serve as an enrollment liaison to providers/groups, departmental contacts, contracted health plans and others entities units across BILHPN network. The PDQA is responsible for the submission & reconciliation of all Enrollment rosters (delegated/Non-delegated). This is essential as delegated rosters submission with the contracted payors will serve as the automated process for initial enrollment of providers. The PEQD analyst will utilize strong analytical, technical, and communication skills to understand, track, and resolve issues with internal and external stakeholders. (Essential)

The Provider Enrollment Quality Data Analyst interacts extensively with provider office staff, BILHPN staff, BILH CVO/Medical staff offices, Database Manager of credentials verification office, health plans representatives from all contracted health plans, including government plans and group leaders, executives of new/existing groups joining the network. (Essential)

The Provider Enrollment Quality Data Analyst will work closely with Staff CVO team, BILH IT for related field needed, update related to Staff Enrollment Market and issues, as well staff training related to PE system.

The PEQDA primary function will be to monitor the quality of data as it relates to managed care/Enrollment. The PEQDA will examine complex Enrollment data to optimize the efficiency, and quality of the data that’s being collected, coordinate all aspects of maintaining accurate and efficient data of BILHPN providers data in MDStaff /Cactus or other provider enrollment system and with BILHPN contracted managed care plans. Participate in cross-functional workgroups as the primary Enrollment data resource for provider enrollment Enrolment Department.

The PEQDA will also work closely with the BILHPN Data Stewards to resolve discrepancies related to for all provider enrollment data requests inquiries to ensure the creation and distribution of needed rosters are successfully create, and timely deliver, and address all Enrollment related issues. (Essential)

The PEQDA is responsible to maintain, monitor, reconcile and analyze BILHPN provider data for accurate and continuous maintenance with BILHPN network and contracted help plans and will help resolve data quality problems, and collaborate internally with various BILHPN departments and external stakeholders to improve the system and accuracy of reports and rosters. Perform periodic stringent data checks to identify an address inconsistent data issues and leak variables in MDStaff Cactus. (Essential)


Essential Duties & Responsibilities including but not limited to:

1. The PEQDA also serve as the day-to-day liaison for new group and existing group joining BILHPN. The PEQDA work closely with Network Relations Team and Enrollment Supervisors on the Onboarding and off boarding of new, existing Tax ID /group joining BILHPN contracts, terminations, as well as coordinating and communicating the TIN information with Enrollment staff and other departments within BILHPN.
2. The PEQDA coordinates and interact professionally with risk owners on their potential new physician practice or group, and (existing members, and other Joining BILHPN network to delivers clear and timely information related BILHPN contracts, risk management, health plan application and enrollment procedure. Ensures accurate and timely acceptance into BILHPN, approvals by BIHLPN and PPLLC boards and timely enrollments with health plans.
Responsible for researching and monitoring any changes/requirements from the health plans and determines appropriate documents for enrollment of each new large group as well as individual practices. (essential). The PEQDA serve as are the first point of contact and primary organizational resource on enrollment forms requirement related to payors.

3. Accuracy and completeness of data. The Provider Enrollment Quality Data Analyst is responsible to performs queries. Identifies continuous quality Serves as the quality control database champion; perform system checks of enrollment related issues including but not limited to the quality control to protect BILHPN's liability to legally bind physicians to contracts not limited to BORIM, CAQH, MHQP databases quality control (QC) of enrollment staff submissions, sanctions queries, and responsible for updating some of the system errors as well as reporting errors to the supervisors and maintains improvement opportunities to enhance provider enrollment operations processes and issues related to delegation within BILH CVO/Medical Staff offices and other organizations. (essential)

4. Supports internal departments with task related to enrollment such as payors roster, provider data counts, BILHPN TIN database extract. Responsible to investigating and resolving any issue related to these reports. (Essential)

5. Develop and consolidating data from related enrollment system
Coordinates all operational aspects of maintaining accurate BILHPN provider data within MDStaff and with various contracted managed care health plans through roster management/ reconciliation and other channels (essential)

6. The Provider Enrollment Quality Data Analyst ensures timely roster enrollments and quality checking of enrollment applications to optimize physician revenue cycles. Responds to requests to Roster enrollment update or change information and ensures that all changes are made within operational guidelines and accurately support all other systems related functions. Interact professionally with management and BILHPN staff to provide appropriate and timely response to inquiries and concerns regarding roster enrollment and data maintenance

7. Under guidance of the supervisors or and Director, prepares and provide communications to Groups and third-party payees for documents required for administration of messenger model contracting as per current anti-trust laws. Responsible for maintaining all TINs Data related to group/risk units and record keeping of all group history/change including Opt-in forms and creating and updating all new groups address es in the provider enrollment system as well as informing internal BILHPN staff. (Essential)

8. Perform periodic stringent data checks to identify and address inconsistent data issues and leak variables in MDStaff (Essential)
Make recommendations to management to improve efficiency effectiveness of current manual processes through systemic modifications.
.
9. Participate along with supervisors with department materials related to Audit, stats, policies, directories and others (Essential)
.
Additional Responsibilities:

1. Assist in preparation of training material, business presentation, and other educational material
2. Performs other duties and special projects as assigned and as needed functions.
3. Other enrollment functions as needed

Organizational Requirements:
Maintain strict adherence to all BILH and BILHPN Policies.
Maintain courteous and effective interactions with colleagues and providers and stake holders.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to customer service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully completes Mandatory Education.
Perform all other duties as needed or directed to meet the needs of the department.

Job Description:

Essential Duties & Responsibilities including but not limited to: 

1.    The PEQDA also serve as the day-to-day liaison for new group and existing group joining BILHPN. The PEQDA work closely with Network Relations Team and Enrollment Supervisors on the Onboarding and off boarding of new, existing Tax ID /group joining BILHPN contracts, terminations, as well as coordinating and communicating the TIN information with Enrollment staff and other departments within BILHPN. 
2.    The PEQDA coordinates and interact professionally with risk owners on their potential new physician practice or group, and (existing members, and other Joining BILHPN network to delivers clear and timely information related BILHPN contracts, risk management, health plan application and enrollment procedure.  Ensures accurate and timely acceptance into BILHPN, approvals by BIHLPN and PPLLC boards and timely enrollments with health plans.  Responsible for researching and monitoring any changes/requirements from the health plans and determines appropriate documents for enrollment of each new large group as well as individual practices. (essential).  The PEQDA serve as are the first point of contact and primary organizational resource on enrollment forms requirement related to payors.

3.    Accuracy and completeness of data. The Provider Enrollment Quality Data Analyst is responsible to performs queries. Identifies continuous quality Serves as the quality control database champion; perform system checks of enrollment related issues including but not limited to the quality control to protect BILHPN's liability to legally bind physicians to contracts not limited to BORIM, CAQH, MHQP databases quality control (QC) of enrollment staff submissions, sanctions queries, and responsible for updating some of the system errors as well as reporting errors to the supervisors and maintains improvement opportunities to enhance provider enrollment operations processes and issues related to delegation within BILH CVO/Medical Staff offices and other organizations.  (essential)

4.    Supports internal departments with task related to enrollment such as payors roster, provider data counts, BILHPN TIN database extract.  Responsible to investigating and resolving any issue related to these reports.  (Essential) 

5.    Develop and consolidating data from related enrollment system
Coordinates all operational aspects of maintaining accurate BILHPN provider data within MDStaff and with various contracted managed care health plans through roster management/ reconciliation and other channels (essential)

6.    The Provider Enrollment Quality Data Analyst ensures timely roster enrollments and quality checking of enrollment applications to optimize physician revenue cycles. Responds to requests to Roster enrollment update or change information and ensures that all changes are made within operational guidelines and accurately support all other systems related functions. Interact professionally with management and BILHPN staff to provide appropriate and timely response to inquiries and concerns regarding roster enrollment and data maintenance 

7.     Under guidance of the supervisors or and Director, prepares and provide communications to Groups and third-party payees for documents required for administration of messenger model contracting as per current anti-trust laws. Responsible for maintaining all TINs Data related to group/risk units and record keeping of all group history/change including Opt-in forms and creating and updating all new groups address es in the provider enrollment system as well as informing internal BILHPN staff.  (Essential)

8.    Perform periodic stringent data checks to identify and address inconsistent data issues and leak variables in MDStaff (Essential). Make recommendations to management to improve efficiency effectiveness of current manual processes through systemic modifications. 
9.    Participate along with supervisors with department materials related to Audit, stats, policies, directories and others (Essential)

Additional Responsibilities:

1.    Assist in preparation of training material, business presentation, and other educational material
2.    Performs other duties and special projects as assigned and as needed functions.
3.    Other enrollment functions as needed

Organizational Requirements: 
Maintain strict adherence to all BILH and BILHPN Policies.
Maintain courteous and effective interactions with colleagues and providers and stake holders.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to customer service standards.
Participate in departmental and/or interdepartmental quality improvement activities.  
Participate in and successfully completes Mandatory Education. 
Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications: 
Education:         Bachelor's degree preferred.

Licensure, Certification & Registration:    

Experience:    5-8 years related work experience required. Provider Enrollment experience is strongly preferred.

Skills, Knowledge & Abilities: 

1.    Understanding of managed care principles and physician practice operations, IPA, PHO with an understanding of health plan provider enrollment and credentialing preferred.

2.    Ability to analyze and evaluate data and other provider related problems in order to develop alternative solutions for a positive outcome.
3.    Collaborative and relationship-driven style in building effective data transmissions between entities.
4.    Ability to use query language to select, extract, and manipulate data. Understanding of strategic enrollment and credentialing with the ability to present findings in a visually compelling way to non-technical audiences is a plus
5.    Exceptional attention to detail and ability to produce accurate work. Demonstrated ability to effectively manage multiple projects simultaneously and meet deadlines. Excellent organizational skills, Proven customer service skills and the ability to successfully analyze and procure solutions to problems in a fast-paced production-based environment. Proven project management expertise

6.    Demonstrated knowledge of health plan credentialing and enrollment processes and requirements including NCQA and JCAHO requirements, licensure requirements, regulations of various agencies such as BORIM, ABMS and individual specialty boards.

7.    Valid driver's license and car required as for external meetings as requested by Supervisors or and Director.

8.    Advanced skills with Microsoft applications which may include Outlook, Word, MDStaff, CACTUS, Excel, PowerPoint or Access and other web- based applications. May produce complex documents, perform analysis and maintain databases

9.    Must possess a high level of technical aptitude and be able to organize and manage information in multiple system environments. Manage multiple priorities, pay close attention to detail as well as be proficient in word processing and spreadsheet applications.

FLSA Status:

Exempt

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled