Provider Enrollment Coordinator 1

Mass General Brigham Health Plan, Inc.; Somerville (MA); Remote; USD 45,000 - 65,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Provider Enrollment Coordinator I to oversee provider enrollment transactions, ensuring data accuracy and resolving issues in collaboration with various departments. The ideal candidate will have a high school diploma and relevant healthcare experience, bringing strong organizational and communication skills to a dynamic healthcare environment.

Qualifications

• Education: High School Diploma or GED equivalent.
• 1-2 years in Healthcare and/or insurance environment required.
• 1-2 years of provider enrollment experience preferred.

Responsibilities

• Process and coordinate all provider enrollment transactions within the Provider Enrollment Portal (PEP).
• Maintain data integrity of provider data and directories.
• Respond to provider letter of interest requests.

Skills

Project Management

Communication Skills

Detail-oriented

Organizational Skills

Education

High School Diploma or GED

Tools

Microsoft Office

QNXT

Job description

Provider Enrollment Coordinator 1 page is loaded

Provider Enrollment Coordinator 1

Apply remote type Remote locations Somerville-MA time type Full time posted on Posted 2 Days Ago job requisition id RQ4022408 Site: Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

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

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.

Additional Job Details (if applicable)

Working Conditions

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

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

EEO Statement:

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Why work here?

Combat disease. Hold a hand. Help people. Impact the world.

Mass General Brigham is a passionate, welcoming community where minds meet caring hearts.

Come be a part of the world’s most powerful force in medicine, where every role is important in changing lives. Are you ready?

About Us?

Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world.

Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community.

We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system.

We recognize that increasing value and continuously improving quality are essential to maintaining excellence.