Provider Enrollment Specialist

2 weeks ago

Lebanon, New Hampshire, United States D-H Lebanon-MHMH Full time
Position Summary
The Enrollment Operations Coordinator is accountable for managing the enrollment of D-HH providers, overseeing Epic SER access, and handling insurance-related claims processes.

Key Responsibilities
  • Act as a key contact between 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 the creation and upkeep of the credentialing database, ensuring accurate entry of new data and updates to existing 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 NCQA/delegated credentialing provider exclusion queries as needed.
  • 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 information.
  • Track and log enrollment confirmations within the credentialing database and Epic, managing claims submissions effectively.
  • Coordinate, schedule, and participate in managed care audits, reviewing files prior to audits.
  • Assist with updates and modifications that impact billing processes.
  • Report on any missing provider information to ensure compliance.
  • Conduct audits of data to guarantee accuracy for payer reporting.
  • Respond to 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 required.
  • Strong written and verbal communication skills are essential.
  • Attention to detail is crucial.
  • Experience with CAQH is preferred.
  • Familiarity with Epic is preferred.
  • 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.

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