Description
At NorthBay Health, the Provider Enrollment analyst is responsible for all Medical Staff and Allied Health Practitioner (AHP) heal plan credentialing and recredentialing with government and commercial health plans. The position is responsible for enrollment, credentialing and termination of NorthBay physicians/providers with NorthBay's contracted health plan partners. This position maintains rosters and functionality that support a compliant provider enrollment process. Additional role responsibilities include compiling and distributing periodic reports, both within the department and throughout the organization as well as investigating and resolving provider enrollment issues. Servies as a resource related to the National Committee for Quality Assurance (NCQA).
PRIMARY JOB DUTIES
Responsible for all enrollment functions, credentialing and termination of providers and select contracted specialists.
Serves as a resource in credentialing standards for NCQA, CMS, Medi-Cal, medical group affiliates and health plans.
Monitors current regulations and enrollment guidelines for payers of all current and future healthcare services.
Proficient in PECOS, PAVE, CAQH, Better Doctors, MD-Staff and other credentialing and enrollment software and websites, and other tools required to enroll, credential and terminate providers.
Coordinates assigned enrollment activities and tracks progress toward established timelines.
Provides enrollment information and support to Administration (Department Directors, Managers, Supervisors), medical staff and hospital personnel in all activities related to provider health plan credentialing requirements.
Responsible for maintaining databases with Medical Staff that support the health plan enrollment functions.
Collaborates with Revenue Cycle to correct any payment deficiencies due to health plan enrollment.
Track, document, communicate, and escalate provider enrollment issues timely and appropriately to department leadership or other stakeholders.
Cross trains with other department Analysts to assist with various system maintenance, updates, etc.
Enhances professional growth and development through educational programs or seminars.
Maintain effective working partnerships internally and externally to support provider enrollment efforts.
Works independently utilizing a high level of initiative, judgement and critical thinking skills.
Qualifications
Licensure/Certification: NCQA health plan accreditation training preferred.
Experience: Minimum 5 years of experience in a corporate business setting, preferably in a health care setting.
Skills: Excellent oral and written communications skills. Must possess teaching ability and demonstrate the ability to efficiently collaborate with others. Capable of communicating effectively at all levels of the organization. Ability to work on multiple projects simultaneously and manage deadlines. Must be highly organized with the ability to set priorities, work independently and be an effective team member. Ability to integrate information from multiple sources into an automated process to effectively manage provider health plan enrollment. Advanced computer skills to include: Microsoft Windows and Office suite, Access, MD Staff, Tableau and other on-line enrollment systems.
Interpersonal Skills: Demonstrates the True North values. The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence. Requires ability to communicate effectively verbally and in writing, good presentation skills, team building, and educational teaching skills.
Hours of Work: Non-exempt. Normally works eight-hour day. Hours will vary according to work demands and project requirements.
Apply on company website
Find Connections via Linkedin
