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Credentialing & Enroll Assoc

Company: Beth Israel Lahey Health
Location: Winchester
Posted on: June 12, 2021

Job Description:

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Job Description

Welcome To

Welcome to Winchester Hospital, part of Beth Israel Lahey Health. Winchester Hospital was the first hospital in Massachusetts to earn Magnet recognition, the American Nurses Association's highest honor for nursing excellence, three times. It has since received the recognition a fourth time. As the northwest suburban Boston area's leading provider of comprehensive health care services, the 229-bed facility provides care in general, bariatric and vascular surgery, orthopedics, pediatrics, cardiology, pulmonary medicine, oncology, gastroenterology, rehabilitation, radiation oncology, pain management, obstetrics/gynecology and a Level IIB Special Care Nursery.

About the Job

JOB SUMMARY: Contributes to the Hospital's mission by verifying physician's applications for privileges and conducting background checks to ensure our physicians meet the health plans' competency standards. Processes paperwork and enrollment applications for physicians and other credentialed providers in WPA, Winchester Healthcare Enterprises, and other Winchester Hospital affiliated entities and payor plans under contract with WPA. This administrative compliance position will have an impact on patient safety and physician engagement and satisfaction by appointing/reappointing providers, and improving the speed by which physicians are activated by payor plans.

QUALIFICATIONS:

Education

Required: High School Diploma or equivalent

Preferred: Associates degree in healthcare or business

Experience

Required: At least one year provider credentialing experience

Preferred: Experience in Medical Staff Office or experience working with physicians

Other Skills/Knowledge

Required:

  • For safety and quality reasons, must be able to read, write and communicate effectively in English with patients, visitors and fellow members of the hospital team.
  • Proficient in word processing, Excel, Internet and database skills.
  • Excellent organization, communication and customer service skills.

LICENSES, REGISTRATIONS, CERTIFICATIONS:

Preferred: Certified Professional Credentials Specialist

LIFE SUPPORT CERTIFICATION REQUIRED: N/A

POPULATION SPECIFIC REQUIREMENTS: N/A

OTHER JOB REQUIREMENTS:

Professional Commitment Requirements: Keep abreast of developments in the field and/or licensure through continuing education, participation in professional organizations or a combination of both.

On-call Requirement: None

Schedule Requirements: General business hours, schedule may vary based on business needs.

Travel Requirements: Based on business needs to better service the physicians.

REPORTING RELATIONSHIPS:

  • Reports to Billing Manager
  • Not responsible for supervising the work of others.

As part of the Physician Billing Services team, this position:

  • Coordinates the credentialing process for physicians and other credentialed providers in WPA, Winchester Healthcare Enterprises, and other Winchester Hospital affiliated entities by using the Board of Registration in Medicine guidelines.
  • Reviews appointment/reappointment applications for completeness, verifies accuracy of required information. Differentiates between credentialing requirements for various practitioners.
  • Contacts practitioner to inquire about missing information and/or discrepancies and keep abreast of status.
  • Inputs information into credentialing software.
  • Maintains accurate and up-to-date practitioner files.
  • Generates required verification letters to ensure verification process proceeds within established time limits.

Payor Plan Enrollment:

  • Processes enrollment applications in a manner of superior customer service to our physicians. While recognizing that ultimately the accuracy and completion of these forms are the physician's responsibilities, does all possible to streamline and ease the process for the physicians, our customers.
  • Investigates application processing conflicts and delays to expedite applications and minimize future problems.

Both

  • With proper authorization, fills data requests/verifications pertaining to privileges, credentials and/or membership enrollment

  • Liaison between Physician Billing Services and its payors as it relates to provider

credentialing or enrollment.

  • Maintains electronic and paper documentation as it relates to our payors.
  • Continually investigates insurance companies' websites for procedures and requirements.
  • Investigates and resolves credentialing/enrollment related billing issues.
  • Assists with other projects and duties as assigned.

Shift

40 hours, full time

About Us

Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve. Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health. Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.

Keywords: Beth Israel Lahey Health, Boston , Credentialing & Enroll Assoc, Other , Winchester, Massachusetts

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