Provider Enrollment Coordinator 1
Provider Enrollment Coordinator 1
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1 Vacancy
Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
The Provider Enrollment Coordinator I is responsible for the processing and coordination of all provider enrollment transactions within the Provider Enrollment Portal (PEP) for monitoring and maintaining the data integrity of Mass General Brigham Health Plan provider data and directories and responding to provider letter of interest requests. S/he works with other Mass General Brigham Health Plan staff to update records resolve provider configuration issues and answer questions about provider enrollment transactions.Essential Functions
Process all provider enrollment transactions within the Provider Enrollment Portal (PEP) including all new ancillary and group contracts new provider affiliations open and close panel requests terminations and demographic changes.
Supports the completion of all enrollment transactions within department-specific turnaround-time standards.
Maintains and updates specific provider information directly in the claim processing system (QNXT).
Coordinates with Credentialing Configuration Member Services and other PNM staff to process enrollment transactions resolve enrollment issues and track the progress of provider transactions through the entire enrollment process.
Maintains provider status lists for larger provider organizations and provide regular status reports to these groups.
Answer questions from various Mass General Brigham Health Plan staff concerning the status of provider enrollment transactions.
Regularly maintains department data quality standards concerning the data entry of all provider transactions. Corrects errors in data and continually looks for opportunities to improve the data integrity of Mass General Brigham Health Plan provider data and directories.
Works with the Contracting and Provider Relations staff to enroll new contracts and continually educates PNM staff on appropriate provider set-up in the system.
Responds to Letter of Interest requests from new provider groups and coordinates the receipt of all required contract material from these provider practices.
Prepares final contracting documents for scanning and long-term storage.
Hold self and others accountable to meet commitments.
Ensure diversity equity and inclusion are integrated as a guiding principle.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
Qualifications
Qualifications
- Education: High school Diploma or GED equivalent.
Experience
- At least 1-2 years of experience in Healthcare and/or insurance environment required
- At least 1-2 years of provider enrollment experience strongly preferred
Knowledge Skills and Abilities
- Knowledge of insurance regulations and managed care contract policies
- Excellent people and project management skills along with excellent written oral and presentation skills
- Demonstrated competence in Microsoft Office including Outlook Word Excel and PowerPoint. Knowledge of the QNXT operating system is preferred.
- Ability to establish a rapport and interact well with individuals on all levels and to maintain a professional image and attitude.
- Detail-oriented able to handle multiple tasks with excellent organizational skills and workplace flexibility.
- Demonstrate Mass General Brigham Health Plans core brand principles of always listening challenging conventions and providing value.
- Bring fresh ideas forward by listening to and working with employees and the people we serve.
- Strong aptitude for technology-based solutions.
- Ability to inject energy when and where its needed.
- Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
- Be accountable for delivering high-quality work. Act with a clear sense of ownership.
- Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Employment Type
Full-Time
