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Provider Enrollment Specialist
2 months ago
Position Overview
The Enrollment Operations Coordinator is accountable for overseeing the provider enrollment process, managing Epic SER access, and handling insurance claims effectively.
Key Responsibilities
- Act as a communication bridge among credentialing teams, contracting departments, external payers, and healthcare facilities.
- Facilitate the enrollment of healthcare providers into both governmental and commercial Managed Medicaid health plans.
- Assist in the creation and upkeep of the credentialing database, ensuring accurate data entry and updates to enrollment records.
- Review claim work queues, perform necessary investigations, and collaborate with relevant parties to rectify edits or resolve denials.
- Oversee the resolution of enrollment challenges to ensure timely and precise reimbursement for services rendered.
- Generate queries for NCQA and delegated credentialing provider exclusions.
- Submit provider demographic information for initial Epic EMR access and manage the termination of inactive provider records.
- Maintain the integrity of Epic provider SER records, focusing on demographics, billing, admissions, and revenue routing.
- Ensure the maintenance of electronic prescribing rights (EPCS) and state licensing information.
- Track and log enrollment confirmations within the credentialing database and Epic, facilitating claims submission control.
- Coordinate and participate in managed care audits, reviewing documentation prior to audits.
- Assist with updates and modifications that impact billing processes.
- Report on any missing provider information.
- Conduct audits to verify data accuracy for payer reporting.
- Address DHSM tickets related to provider access issues.
- Perform additional duties as assigned.
Qualifications
- High School diploma or equivalent is required.
- A minimum of two years of experience in the healthcare sector is necessary.
- Strong written and verbal communication skills are essential.
- Attention to detail is a must.
- Experience with CAQH and Epic is preferred.
- Proficiency in word processing, spreadsheet software, database management, and data entry is preferred.
Remote Work: This position is fully remote.
Area of Interest: Professional/Management
Shift: Day
Equal Opportunity Employer: Dartmouth Health is committed to diversity and inclusion, providing equal employment opportunities without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status, and does not discriminate based on disability.
