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Incumbent is accountable for a contribution to the revenue of Baystate Health System through the maintenance of providers with government and commercial health plans.

Under direction of the Manager, Provider Enrollment and Business Intelligence and the Supervisor of Provider Enrollment, the position is responsible for a variety of duties related to the initial enrollment, re-enrollment and termination, of participation for Baystate Health System physicians and other professional providers.

The incumbent must maintain good working relationships and communication channels with a number of internal and external parties. Internally, those include individual providers, practice managers, Medical Staff Office, Physician Billing Office, Baycare Health Partners and Corporate Risk Management. Externally, those include payor credentialing departments; Centers for Medicare and Medicaid, applicable managed care organizations, and other state and federal agencies.

The incumbent will be primarily responsible for provider re-enrollment, and termination activities and may support the Provider Enrollment Specialist with initial enrollment work. The incumbent will be responsible to gather and compile renewed licensure, board and insurance information and maintain this information in provider enrollment files, databases and with appropriate payors. The incumbent must review provider information for accuracy and completeness and follow-up with providers to fill in any gaps in the information. Working with the Provider Enrollment Specialists the incumbent will assist in follow-up work with the plans in a manner that assures minimal or no delays in ascertaining the status of applications.

Incumbent must maintain orderly, complete and up to date files on each individual provider. The files serve as a source of official record of information submitted to plans, and help to assure maximum efficiency in processing initial and re-credentialing applications. The incumbent must adhere to established procedures and controls to provide follow-up and reporting on outstanding provider enrollment issues, as well as maintaining provider enrollment reports and other records of provider enrollment activity.

The incumbent must be able to work independently, but have the ability to judge when issues should be brought to a specialist or management for resolution.

Job Responsibilities:

+ General Provider Enrollment activities

+ Completes the submission of Provider Re-enrollment applications

+ Provides adequate follow-up on applications in process and on outstanding enrollment issues and information

+ Records management

+ Special projects

+ Individual and/or team objectives from previous review cycle

Required Work Experience:

+ 1-2 years experience in physician enrollment or physician related field

+ Highly proficient in current Microsoft environment, relational databases, spreadsheets, word processing and e-mail systems

+ Ability to organize workload and manage multiple projects within deadlines

+ Demonstrates service excellence, detail orientation, superb organizational skills and follow-through

+ Demonstrated ability to maintain professional demeanor and presentation under all circumstances

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

GED or HiSET (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.