Massachusetts Jobs

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.

What We're Looking For:

Required:

High School Diploma or equivalent.

Required:

• Two years' experience in a provider enrollment setting (managed care, insurance, medical, or related field).

Preferred:

• Experience enrolling clinicians in Medicare, MassHealth, private insurance and hospitals preferred.

Required:

• Professional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn Credentialing Software.

• Proficient in Microsoft Office Suite

• Detail-oriented, analytical, organized and possessing problem-solving skills.

• Ability to manage varying job pressures and meet deadlines and handle multiple tasks simultaneously with minimal supervision.

• Ability to work in a production environment and meet production and quality goals.

• Ability to independently organize workload and manage multiple projects within deadlines.

• Computer literacy and experience with Microsoft office suite (Outlook, Word and Excel), Adobe Pro and internet searches. Knowledge working with fax machines, copiers and other office machines.

• Ability to prepare, send and track standard mailings, certified mailings, FedEx mailings.

• Knowledge of regulatory/accreditation requirements and standards (CMS, DOH, HIPAA, NCQA).

• Knowledge of Medicare, MassHealth, EOHHS health care programs and understanding of program and provider enrollment and credentialing regulations and requirements preferred.

• Ability to establish and maintain positive relationships, building trust and respect by consistently meeting and exceeding expectations.

Required:

English

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.