Provider Enrollment Specialist
Company: TalentBoost (Point32Health)
Location: East Providence
Posted on: January 24, 2023
Job Description:
Under direction of the Provider Enrollment Supervisor, the
Provider Enrollment Specialist processes, maintains, and revises
all components of the provider information database for all
Point32Health products/plans. The candidate is responsible for the
integrity of all practitioner information housed in the company's
provider data systems and communicates with both internal and
external customers by telephone, email, and facsimile and in
writing regarding practitioner information. The Specialist has
comprehensive knowledge of IPA (Independent Practitioners
Affiliations) specifics and is in contact with their counterpart
regarding individual providers as well as changes within the IPA
organization, working closely with the Contract Administrator to
keep our Provider Network current. The Specialist also has
knowledge regarding contracts and tax id forms, and many other
supporting documents, as well as claims payment and claims forms
and is a resource externally for providers and internally for
numerous departments such as claims, member services, provider
services, network contracting, and others.Key
Responsibilities/Duties- what you will be doing:
- Responsible for assessment, validation and collection of
appropriate contracts and supporting documents prior to adding or
modifying provider data. Responsible for the execution of
consistent, quality data input of provider information through
discussion and discovery with providers and their contacts prior
entering data into complex data systems
- Data entry of the elements as indicated above.
- Responsible for maintaining various reporting tools and quality
metrics for tracking provider information changes, including, but
not limited to the Practitioner Change Reports for Commercial and
Medicare Preferred.
- Communicate and confirm provider information changes to
individual provider and designated internal departments.
- Works with providers, directly and through other internal
departments, to resolve conflicts over provider status and other
issues.
- Evaluate and assess correspondence directly from providers
and/or internal departments regarding provider status or changes
and maintain three databases as necessary.
- Responsible for resolving tax identification issues for
providers identified by the Internal Revenue Service.
- Verify data is correct and complete in provider files for newly
credentialed practitioners, and other providers including ancillary
providers and/or ancillary facilities.
- Ensure the adequacy and reliability of all information
necessary for Provider Unit, Medical Groups, and Plan
membership.
- Daily, resolve and document issues requested in a timely
manner, consistent with established dept standardsQualifications-
what you need to perform the jobEducation, Certification and
Licensure
- B.A./B.S. or equivalent in health care or related field
preferred.Experience (minimum years required):
- At least one year of experience in the Provider Information
Department. Academic concentration in health care field or 1-2
years' experience in health care field. Experience with personal
computer required. Experience in database management systems
preferred. Knowledge of Windows, Microsoft Word, Excel
preferred.Skill Requirements
- Must have the ability to maintain and manipulate a complex
provider database. Must be able to prioritize multiple tasks and
achieve deadlines.
- Must have ability to adapt to a changing environment.
- The position requires the ability to analyze and understand
complex payment issues and plan operational concerns. Strong
written and verbal skills are necessary.
- Individual must possess initiative, judgment, exceptional
organizational skills as well as a keen attention to detail.
- Must be able to work cooperatively as a team member.
- Frequent contact, both written and verbal, with practitioners,
office staff, billing agents and internal customers. Must use
discretion when dealing with Plan providers and all other
departments.Working Conditions and Additional Requirements (include
special requirements, e.g., lifting, travel):
- Must be able to work under normal office conditions and work
from home as required.
- Work may require simultaneous use of a telephone/headset and
PC/keyboard and sitting for extended durations.
- May be required to work additional hours beyond standard work
schedule.DISCLAIMER:The above statements are intended to describe
the general nature and level of work being performed by employees
assigned to this classification. They are not intended to be
construed as an exhaustive list of all responsibilities, duties and
skills required of employees assigned to this position. Management
retains the discretion to add to or change the duties of the
position at any timeCommitment to Diversity, Equity &
InclusionPoint32Health is committed to making diversity, equity,
and inclusion part of everything we do-from product design to the
workforce driving that innovation. Our DEI strategy is deeply
connected to our core values and will evolve as the changing nature
of work shifts. Programming, events, and an inclusion
infrastructure play a role in how we spread cultural awareness,
train people leaders on engaging with their teams and provide
parameters on how to recruit and retain talented and dynamic
talent. We welcome all applicants and qualified individuals, who
will receive consideration for employment without regard to race,
color, religion, gender, gender identity or expression, sexual
orientation, national origin, genetics, disability, age, or veteran
status.COVID PolicyPlease note: As of January 18, 2022, all
employees - including remote employees - must be fully vaccinated.
This position will require the successful candidate to show proof
of full vaccination against COVID-19. Point32Health is an equal
opportunity employer, and will consider reasonable accommodation to
those individuals who are unable to be vaccinated consistent with
federal, state, and local law.About the CompanyPoint32Health is a
leading health and wellbeing organization, delivering an
ever-better personalized health care experience to everyone in our
communities. At Point32Health, we are building on the quality,
nonprofit heritage of our founding organizations, Tufts Health Plan
and Harvard Pilgrim Health Care, where we leverage our experience
and expertise to help people find their version of healthier living
through a broad range of health plans and tools that make
navigating health and wellbeing easier.We enjoy the important work
we do every day in service to our members, partners, colleagues and
communities.This job has been posted by TalentBoost on behalf of
Point32Health. TalentBoost is committed to the fundamental
principle of equal opportunity and equal treatment for every
prospective and current employee. It is the policy of TalentBoost
not to discriminate based on race, color, national or ethnic
origin, ancestry, age, religion, creed, disability, sex and gender,
sexual orientation, gender identity and/or expression, military or
veteran status, or any other characteristic protected under
applicable federal, state or local law.Req ID:R5887
Keywords: TalentBoost (Point32Health), East Providence , Provider Enrollment Specialist, Other , East Providence, Rhode Island
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