Why This Role is Important to Us
The Provider Enrollment Specialist facilitates the paperwork and timely follow through of all required CCA and CCC employed clinician licenses, registrations, hospital affiliations and insurance enrollments including, but not limited to, state license, DEA & MCSR renewals, NPI registration, CAQH applications, Medicare & MassHealth enrollment, private insurances (e.
g. Tufts, BCBS) and hospital credentialing (e.g. Boston Medical Center, Massachusetts General).
What You'll Be Doing
- Enroll and Re-enroll individual practitioners using Credentialing Software.
- Outreach to providers (email, phone, in person) to obtain additional supporting documentation or information.
- Meet in person with employed clinicians and Clinical Directors to facilitate filling out required paperwork, obtaining signatures, and troubleshoot issues related to enrollment submissions.
- Monitor work inventory to ensure inventory is processed within expected turnaround times.
- Meet or exceed departmental production and quality goals.
- Display a positive, constructive and helpful demeanor.
- Assist Provider Data Management (PDM) team in data entry of key provider demographics and data integrity projects including but not limited to outreaching for additional details required to update CACTUS Credentialing Software's database and directory.
- On site audits of perspective Provider Groups as required (i.e. Frail Elderly Waiver)
- Other duties as assigned.
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The Provider Enrollment Specialist facilitates the paperwork and timely follow through of all required CCA and CCC employed clinician licenses, registrations, hospital affiliations and insurance enrollments including, but not limited to, state license, DEA & MCSR renewals, NPI registration, CAQH app...
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