Enrollment Specialist

• Complete the government payer enrollment process for all new individual providers and groups/locations within established timeframes
• Obtain information needed for government payer applications from individual providers and existing Medical Staff Administration and/or network development records
• Complete maintenance updates and re-verification/re-validation for individual providers and groups/locations
• Maintain and update provider and group/location data, including name changes, office locations, demographics, new groups, and TINs
• Populate and update internal and external databases reflecting non-commercial payer participation and related data
• Submit enrollment applications to appropriate state Medicare/Medicaid programs before Credentials Committee meetings or applicant approvals
• Submit enrollment applications to appropriate state Medicare/Medicaid programs before opening or acquiring groups/locations
• Collaborate with the multi-disciplinary onboarding group and practitioners to complete application processes
• Ensure continuous, uninterrupted participation status and provider ability to order, refer, and prescribe

• Complete enrollment and health plan recredentialing applications under the direction of the Manager, Provider Enrollment
• Maintain the physician database and serve as a resource to providers, practice staff, BIDCO staff, and health plan representatives
• Facilitate timely enrollment of new providers and existing providers in newly contracted health plans
• Compile confidential data and accurate health plan application packets
• Review returned applications for accuracy and completeness before submission
• Perform provider recredentialing every two years and track applications through completion
• Input and maintain enrollment information and ongoing changes in the provider database
• Communicate with health plans, clinicians, and practice staff regarding provider participation and status
• Develop reporting mechanisms to keep providers and administrators informed of health plan status
• Investigate and resolve enrollment problems affecting billing and reimbursement
• Assist with applications for new group entities joining BIDCO and coordinate required documentation
• Coordinate with local community hospitals regarding hospital privileges and relevant documents
• Facilitate the delegated credentialing process with affiliated Professional Staff Affairs offices

Senior Enrollment Specialist

• Complete government payer enrollment processes for new individual providers and groups/locations
• Obtain information from providers and leverage information from Medical Staff Administration and network development staff
• Complete maintenance updates and re-verification/re-validation for providers and groups/locations
• Maintain and update provider and group/location data, including name, office location, demographic, group, and TIN changes
• Populate and update internal and external databases with government payer participation data
• Submit enrollment applications to state Medicare/Medicaid programs before Credentials Committee meetings or applicant approvals
• Submit enrollment applications to state Medicare/Medicaid programs before opening or acquiring groups/locations
• Collaborate with the multi-disciplinary onboarding group and practitioners to complete application processes

• Complete the government payer enrollment process for new individual providers and groups/locations
• Obtain information needed for government payer applications from providers and existing organizational records
• Complete maintenance updates and re-verification/re-validation for providers and groups/locations
• Maintain provider and group/location data, including name, office location, demographic, group, and TIN changes
• Populate and update internal and external databases reflecting government payer participation and related data
• Submit enrollment applications to appropriate state Medicare/Medicaid programs before Credentials Committee meetings or applicant approvals
• Submit enrollment applications before opening or acquiring groups/locations
• Collaborate with the multidisciplinary onboarding group and practitioners to complete application processes