Provider Enrollment and Credentialing Assistant

Community Healthlink - Worcester, MA

Community Healthlink, Inc. is a multi-service, private, non-profit organization committed to promoting, maintaining and restoring the dignity, well-being and mental health of individuals and families in Central Massachusetts. We are seeking a full-time (37.5 hours/week) Provider Enrollment and Credentialing Assistant in central Massachusetts.

The Provider Enrollment and Credentialing Assistant performs a variety of administrative duties required for timely enrollment of new providers with 3rd party insurance plans and for maintaining enrollment of active providers. They work with CHL providers, Human Resources, Clinical Divisions, Patient Accounts, and Information Services to facilitate credentialing and enrollment to maximize reimbursement for services rendered

Compensation based on education and related work experience, licensure and other qualifications
Health and Dental insurance (available upon starting)
Generous paid sick, personal, holiday, and vacation time
CEU benefits
Life and Disability insurance
401k with agency contribution
Wellness activity discounts
Work related travel reimbursement

Maintains Provider Enrollments Prepares individual provider applications, staff rosters, re-enrollment, and terminations forms and submits them to 3rd party insurance plans.
Communicates with Payers Interacts directly with 3rd party insurance plans to insure email and package receipt, track applications, verify accurate provider status, and resolve issues.
Works with Providers Communicates enrollment requirements, completes applications, verifies information, and obtains signatures.
Supports Credentialing Helps with provider credentialing tasks and accesses confidential and secure federal, state, and private databases.
Maintains Data Enters and updates provider information in electronic health records, billing system, and department databases.
Follows Timely Processes Produces status reports and tracking spreadsheets.
Coordinates with Managers Clarifies provider start dates, practice locations, specialty areas, privileges, and enrollment status.
Maintains Facility Enrollments Prepares and submits facility and site applications to 3rd party insurance plans.
Assists the Chief Operating Officer with some light contract duties (filing, contract set up in contracts database, and renewal reminders)
Participates in internal and external meetings to communicate provider enrollment issues and facilitate/expedite the enrollment processes.
Maintains up-to-date knowledge of changing 3rd party insurance plan participation requirements and recommends revisions to CHL enrollment procedures.
Complies with federal and state regulations, payer requirements, and CARF standards.
Works with extremely confidential and sensitive provider and CHL information.
Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors

High school degree/GED/HiSet required; Associates Degree or higher preferred.
MUST have at least two years of relevant work experience in provider enrollment, or credentialing in health care settings or 3rd party insurance plans.
Professional and effective interaction and communication skills with 3rd party insurance plans, health care providers, and managers.
Ability to prioritize and organize multiple tasks.
Strong attention to detail.
Ability to identify problems in enrollment process and problem-solve issues as they arise.
Skilled in Word and Excel and experience with Microsoft Office.
Ability to function independently and perform routine department procedures without supervision.
Ability to adapt to constantly changing 3rd-party insurance plan rules and regulations.
Proven ability to maintain sensitive and confidential information.
Must be able to pass a CORI background check
Community Healthlink is an Affirmative Action/ Equal Opportunity Employer. We do not discriminate in employment and personnel practices on the basis of race, sex, gender identity, age, ancestry, disability, religion, national origin, marital status, sexual preference, political affiliation or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above listed items.
If applicable, Community Healthlink shall also abide by the requirements of 41 CFR 60-300.5(a) and 41 CFR 60-741.5(a). These regulations prohibit discrimination against qualified protected veterans and qualified individuals on the basis of disability. These regulations require affirmative action by Community Healthlink to employ and advance in employment qualified protected veterans and individuals with disabilities.