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Provider Enrollment Specialist
2 months ago
Position Overview
The Enrollment Operations Coordinator is pivotal in managing the enrollment processes for D-HH providers, overseeing Epic SER access, and handling insurance claims management.
Key Responsibilities
- Act as a liaison among D-HH credentialing, D-H contracting, Conifer RMD, external payors, and healthcare facilities.
- Facilitate provider enrollment for participation in Governmental and contracted Commercial/Managed Medicaid health plans.
- Assist in developing and maintaining the credentialing database, ensuring accurate data entry and updates of enrollment records.
- Review claim work queues, conduct necessary investigations, and collaborate with relevant parties to rectify edits or address claim denials.
- Oversee the resolution of enrollment-related issues to ensure timely and accurate reimbursement for services rendered.
- Generate NCQA/delegated credentialing provider exclusion queries.
- Submit provider demographic information for initial Epic EMR access and manage the termination of inactive provider records.
- Maintain various aspects of the Epic provider SER records, including demographics, billing, admitting, and revenue routing.
- Ensure the maintenance of electronic prescribing rights (EPCS) and state license data.
- Track and enter enrollment confirmations into the credentialing database and Epic, managing claims submissions effectively.
- Coordinate, schedule, and participate in managed care audits, reviewing files in advance of audits.
- Assist with updates and changes affecting service billing procedures.
- Report on missing provider information and audit data to ensure accuracy for payer reporting.
- Respond to DHSM tickets regarding provider access issues.
- Perform additional duties as required or 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 crucial.
- Experience with CAQH and Epic is preferred.
- Proficiency in word processing, spreadsheet software, database management, and data entry is preferred.
Licensure/Certifications
None required.
Work Environment
This position is fully remote.
Area of Interest
Professional/Management.
Shift
Day shift.
Dartmouth Health is committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
