Provider Enrollment Coordinator 1

Mass General Brigham Health Plan; Somerville (MA); On-site; USD 45,000 - 65,000; Full time

Job summary

A leading healthcare organization seeks a Provider Enrollment Coordinator I to manage provider enrollment transactions and maintain data integrity within their systems. The ideal candidate will have experience in healthcare or insurance, with a focus on organizational and communication skills. This remote role offers the opportunity to contribute to a collaborative team dedicated to a people-first approach.

Qualifications

• 1-2 years of experience in a healthcare/insurance environment.
• 1-2 years of provider enrollment experience preferred.

Responsibilities

• Process provider enrollment transactions within the Provider Enrollment Portal.
• Maintain data integrity for provider data and directories.
• Coordinate with multiple departments on enrollment issues.

Skills

Project management

Detail-oriented

Communication

Microsoft Office

Interpersonal skills

Education

High school Diploma or GED equivalent

Tools

QNXT

Job description

The Provider Enrollment Coordinator I is responsible for the processing and coordination of all provider enrollment transactions within the Provider Enrollment Portal (PEP), for monitoring and maintaining the data integrity of Mass General Brigham Health Plan provider data and directories, and responding to provider letter of interest requests. S/he works with other Mass General Brigham Health Plan staff to update records, resolve provider configuration issues, and answer questions about provider enrollment transactions..
Essential Functions
*Process all provider enrollment transactions within the Provider Enrollment Portal (PEP), including all new ancillary and group contracts, new provider affiliations, open and close panel requests, terminations, and demographic changes.
*Supports the completion of all enrollment transactions within department-specific turnaround-time standards.
*Maintains and updates specific provider information directly in the claim processing system (QNXT).
*Coordinates with Credentialing, Configuration, Member Services and other PNM staff to process enrollment transactions, resolve enrollment issues, and track the progress of provider transactions through the entire enrollment process.
*Maintains provider status lists for larger provider organizations and provide regular status reports to these groups.
*Answer questions from various Mass General Brigham Health Plan staff concerning the status of provider enrollment transactions.
*Regularly maintains department data quality standards concerning the data entry of all provider transactions. Corrects errors in data and continually looks for opportunities to improve the data integrity of Mass General Brigham Health Plan provider data and directories.
*Works with the Contracting and Provider Relations staff to enroll new contracts and continually educates PNM staff on appropriate provider set-up in the system.
*Responds to Letter of Interest requests from new provider groups and coordinates the receipt of all required contract material from these provider practices.
*Prepares final contracting documents for scanning and long-term storage.
*Hold self and others accountable to meet commitments.
*Ensure diversity, equity, and inclusion are integrated as a guiding principle.
*Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
*Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

Qualifications

• Education: High school Diploma or GED equivalent.

Experience

• At least 1-2 years of experience in Healthcare and/or insurance environment required
• At least 1-2 years of provider enrollment experience strongly preferred

Knowledge, Skills, and Abilities

• Knowledge of insurance regulations and managed care contract policies
• Excellent people and project management skills, along with excellent written, oral, and presentation skills
• Demonstrated competence in Microsoft Office, including Outlook, Word, Excel, and PowerPoint. Knowledge of the QNXT operating system is preferred.
• Ability to establish a rapport and interact well with individuals on all levels and to maintain a professional image and attitude.
• Detail-oriented, able to handle multiple tasks with excellent organizational skills and workplace flexibility.
• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

Working Conditions

• This is a remote role that can be done from most US states

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.