I. GENERAL SUMMARY:
The Provider Enrollment and Database Specialist is responsible for the day to day operations of provider enrollment for the network. Provider enrollment consists of following established processes with the health plans, LCOs and providers to ensure proper enrollment, credentialing, demographic changes and general health plan issues are handled. The Provider Enrollment and Database Specialist is also responsible for maintaining information in the Salesforce database. The Provider Enrollment and Database Specialist reports to the Provider Enrollment and Database Team Lead, and helps to support the Account Managers, LCO Leadership, providers and office staff to effectively manage the enrollment and credentialing process and communicate on statuses. Must be able to work independently as well as in a collaborative team setting and to handle multiple tasks simultaneously. Performs duties requiring expert level organization, detail and follow-up skills.
II. PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:
- Facilitate process for new providers joining an LCO using the Enrollment Policies and Procedures and ensure completion of payor enrollment requirements for access to NEQCA contracts
- Facilitate process for providers leaving an LCO using the Termination Policies and Procedures and ensure completion of payor termination from the NEQCA contracts
- Work collaboratively with payors to facilitate issues resolution, enrollment and termination requirements
- Assist in maintaining accurate LCO, provider, practice and payor information in the Provider Database
- In depth knowledge of the SalesForce database after receiving training
- Assist in the process of physician roster reconciliations with various LCOs and payors as needed
- Produce reports out of the provider database as needed
- Maintain tracking and documentation of enrollments and terminations
- Maintain and document current inventory of NEQCA and payor specific enrollment documents and requirements
- Continuously monitor enrollment process for improvements
- Collaborate with Manager of Network Operations and Network Database Specialists on various initiatives and projects
- Maintain collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group's achievement of goals, and to help foster a positive work environment
- Perform other similar and related duties as required or directed
III. JOB REQUIREMENTS
- Working knowledge of SalesForce
- Knowledge of health plans and enrollment/termination requirements
- Excellent organizational and follow up skills
- Excellent communication skills
- Creative thinking and problem solving skills
- Ability to work well independently and also effectively within a team
- High level knowledge of Microsoft Office Excel
- Use of Microsoft Outlook
Associates degree preferred
Minimum 4 years' experience in healthcare office environment preferred.
An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.
IV. WORKING CONDITIONS/PHYSICAL DEMANDS:
AMERICANS WITH DISABILITIES STATEMENT:
- Work is in a fast-paced office-based setting.
Must be able to perform all essential functions of this position with reasonable accommodation if disabled.