When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
The HMFP Provider Enrollment Coordinator manages the process of enrolling healthcare providers with various insurance payers and government programs. This role involves preparing and submitting applications, maintaining accurate provider data, and ensuring compliance with payer and regulatory requirements. Key responsibilities include coordinating with providers and internal departments to gather necessary documentation and resolving issues related to enrollment status.
Additionally, this role supports the full lifecycle of provider credentialing by overseeing updates, revalidations, and issue resolution to keep enrollment activity moving efficiently. It works closely with multiple departments and billing partners to ensure data accuracy across EPIC and payer systems while upholding all regulatory standards. The position requires strong analytical, communication, and customer service skills, along with the ability to prioritize complex tasks with precision. This hybrid role reports onsite to Woburn on Tuesdays and Wednesdays and contributes to ongoing operational projects as needed.
Job Description:
Essential Responsibilities:
Provider Enrollment
· Prepare and submit new provider and group enrollments, re-enrollments, and updates to various government and third-party payers for HMFP & AP HMFP.
· Coordinate with providers and internal staff to collect necessary credentials, such as licenses, certifications, and insurance information.
· Successfully implement the entire enrollment process for all providers, adhering to all timelines while maintaining strict confidentiality for matters pertaining to provider credentials
· Effectively communicate with HMFP & Billing Partner staff, Department Assistants, and providers to ensure the timely completion
· Complete revalidation of previous HMFP-enrolled providers and groups.
· Communicate with insurance payers to resolve provider enrollment issues.
· Release claims held due to pending enrollment completions and denial follow-up as needed.
· Stay current on federal, state, and payer-specific enrollment policies and regulations to ensure the organization's compliance.
· Communicate with payers to resolve issues that prevent enrollment completion and follow up on denied claims.
Customer Service:
· Support co-workers and engage in positive interactions.
· Communicate professionally and in a timely with internal and external customers.
· Demonstrate friendliness by smiling and making eye contact when greeting all customers.
· Provide helpful assistance in anticipating and responding to the needs of our customers.
· Collaborate with customers in planning and decision-making to result in optimal solutions
EPIC Responsibilities
· Accurately input and maintain provider information in EPIC enrollment systems and databases
· EPIC Provider Enrollment Table updates while troubleshooting or entering new provider effective dates.
· Work the EPIC Provider Enrollment follow-up Work Queue, troubleshooting with both billing partners, BILPN and HMFP, to resolve
· Work the HMFP student Taxonomy Work Queue, by working with the departments and their new and graduating providers, their correct taxonomy is updated in NPPES. The Provider Enrollment Coordinator will submit a ticket to update the Provider's taxonomy number and update the CMS specialty code for the provider's new board certification
· Document SCA authorizations in the referral & authorization shell in EPIC, as well as scan documentation to the media tab
Required Qualifications:
· High School diploma or GED required. Bachelor's degree preferred.
· Epic Experience Preferred
· 1-3 years of related work experience required.
· Demonstrated cash reconciliation experience within healthcare or a financial environment.
· Strong analytical ability to identify, investigate, analyze, and resolve issues.
· Efficient and effective time management skills; ability to multitask and prioritize work with a strong attention to detail.
· Advanced skills with Microsoft applications, which may include Outlook, Word, Excel, PowerPoint, or Access, and other web-based applications. May produce complex documents, perform analysis, and maintain databases.
Competencies:
· Decision Making: Ability to make decisions that are guided by precedents, policies, and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
· Strong organizational and communication skills.
· Problem Solving: Ability to address varied problems, requiring analysis or interpretation of the situation using direct observation, knowledge, and skills based on general precedents.
· Independence of Action: Ability to set goals and determine how to accomplish defined results with some guidelines. The Billing Manager & Revenue Cycle Director provide broad guidance and overall direction.
Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families, and external customers.
Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures, and policies with the ability to use them in varied situations.
Team Work: Ability to work collaboratively in small teams to improve the operations of the immediate work group by offering ideas, identifying issues, and respecting team members.
Customer Service: Ability to provide a high level of customer service to patients, visitors, staff, and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem-solving. Ability to remain calm in stressful situations.
Physical Nature of the Job: Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, or pulling objects. Sitting most of the time, with walking and standing required only occasionally
Additional Job Description: Ad hoc projects and analysis as needed per the Director of Revenue Cycle Operations.
Pay Range:
$52,000.00 USD – $72,124.00 USD
The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.
