Provider Payer Enrollment Specialist

Beth-Israel-Lahey-Health; Wakefield (MA); On-site; USD 29,000 - 44,000; Full time

Job summary

Beth-Israel-Lahey-Health is seeking a professional to manage government payer enrollment for new individual providers and groups/locations. You will collect enrollment data, maintain records, and ensure timely completion of related applications while coordinating with Medical Staff Administration and network development teams.

The role requires 2–3 years of experience in non-commercial payer enrollment, strong data management, and effective communication, with CPCS or PESC certification

Qualifications

• Bachelor's Degree or equivalent education and experience.

Responsibilities

• 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.

Skills

Provider enrollment

Data maintenance

Effective communication

Education

Bachelor's degree or equivalent education and experience

Tools

Databases

Job description

Beth-Israel-Lahey-Health is seeking a professional to manage government payer enrollment for new individual providers and groups/locations. You will collect enrollment data, maintain records, and ensure timely completion of related applications while coordinating with Medical Staff Administration and network development teams.

The role requires 2–3 years of experience in non-commercial payer enrollment, strong data management, and effective communication, with CPCS or PESC certification