Healthcare Payer Enrollment & Credentialing Specialist

Beth Israel Lahey Health; Wakefield (MA); Remote; USD 29.000 - 45.000; Vollzeit

Zusammenfassung

Beth Israel Lahey Health in Wakefield, MA is hiring a Provider Enrollment Specialist to manage government payer enrollment for individual providers and groups/locations, ensuring timely enrollment and ongoing credentialing. You will maintain data, support re-verification, and coordinate with staff to meet state and federal requirements.

Requirements include a Bachelor's degree or equivalent, 2–3 years in non-commercial payer enrollment, and strong communication skills. CPCS or PESC is preferred.

Qualifikationen

• Bachelor's Degree or equivalent education and experience.
• Minimum of 2-3 years experience in non-commercial payer enrollment.
• Provider enrollment technical proficiency and professional communication skills.
• CPCS or PESC Certification preferred but not required

Aufgaben

• Completes the government payer enrollment process for all new individual providers and groups/locations within established timeframes.
• Obtains information needed for government payer application process from individual providers as well as leveraging information on file, already available within Medical Staff Administration and/or network development staff.
• Completes maintenance updates and re-verification/re-validation for all both individual providers and groups/locations within established timeframes.
• Maintains and updates data on both individual providers and groups/locations including, but not limited to name changes, office location and demographic changes, linking practitioners to new groups, TINs.
• Responsible for populating and updating various databases, internal and external, to accurately reflect non-commercial (government) payer participation and related data.
• Prior to each Credentials Committee meeting or approval of applicants by the Credentials Committee; submits enrollment applications to appropriate state(s) Medicare/Medicaid programs.
• Prior to opening or acquisition of groups/locations submits enrollment applications to appropriate state(s) Medicare/Medicaid programs.

Kenntnisse

Payer enrollment

Communication skills

Professional demeanor

Ausbildung

Bachelor's Degree or equivalent

Jobbeschreibung

Beth Israel Lahey Health in Wakefield, MA is hiring a Provider Enrollment Specialist to manage government payer enrollment for individual providers and groups/locations, ensuring timely enrollment and ongoing credentialing. You will maintain data, support re-verification, and coordinate with staff to meet state and federal requirements.

Requirements include a Bachelor's degree or equivalent, 2–3 years in non-commercial payer enrollment, and strong communication skills. CPCS or PESC is preferred.