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Provider Enrollment Specialist

2 months ago


Lebanon, New Hampshire, United States D-H Lebanon-MHMH Full time
Overview
Responsible for overseeing the enrollment processes for D-HH providers, managing Epic SER access, and handling insurance claims effectively.
Key Responsibilities
1. Act as a key point of contact between D-HH credentialing, D-H contracting, Conifer RMD, external payors, and healthcare facilities.
2. Facilitate the enrollment of providers into networks for participation with both Governmental and contracted Commercial/Managed Medicaid health plans.
3. Assist in the creation and upkeep of the credentialing database, ensuring accurate entry of new data and updates to existing enrollment records.
4. Review claim work queues, conduct necessary investigations, and collaborate with relevant parties to rectify edits or resolve denials.
5. Manage the resolution of enrollment-related issues to ensure timely and accurate reimbursement for services rendered.
6. Generate NCQA/delegated credentialing provider exclusion queries as needed.
7. Submit provider demographic information for initial Epic EMR access and manage the termination of inactive provider records.
8. Maintain various aspects of the Epic provider SER records, including demographics, billing, admitting, and revenue routing.
9. Ensure the maintenance of electronic prescribing rights (EPCS) and state license data.
10. Track and enter enrollment confirmations into the credentialing database and Epic, overseeing claims submissions.
11. Coordinate, schedule, and participate in managed care audits, reviewing files prior to the audit process.
12. Assist with updates and modifications that impact billing procedures.
13. Report on any missing provider information.
14. Conduct audits of data to guarantee accuracy for reporting to payers.
15. Address DHSM tickets related to provider access issues.
16. Perform additional duties as required or assigned.
Qualifications
- High School diploma or equivalent required.
- Minimum of two years of experience in the healthcare sector is essential.
- Strong written and verbal communication skills are a must.
- Attention to detail is crucial.
- Experience with CAQH is preferred.
- Familiarity with Epic is advantageous.
- Proficiency in word processing, spreadsheet software, database management, and data entry is preferred.
Licensure/Certifications
- None required.
Area of Interest: Professional/Management
FTE/Hours per pay period: hrs/week
Shift: Day
Job ID: 25980
Dartmouth Health is an Affirmative Action and Equal Opportunity Employer. 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.