Manager, Provider Enrollment

POSITION SUMMARY :

Under the supervision of the Associate Director, Medical Staff Office, the Enrollment Manager, will provide high level management and direction for the day-to-day operations of provider enrollment applications/renewals for all licensed independent providers at Boston Medical Center Health System. Through comprehensive knowledge of current regulatory requirements for NCQA, health plans, and other applicable agencies, they will implement process enhancements to support organizational growth and improve operational efficiency.

Position: Manager, Provider Enrollment

Department: Provider Enrollment Office

Schedule: Full Time

Onsite: Boston, MA , Hybrid

#LI-Hybrid

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Responsible for coordination and tracking of 3rd Party Enrollment, ensuring timely enrollment and re-enrollment of providers, and serving as the primary liaison between the payors, the FPF, the Medical Staff office and hospital departments.
• Responsible for designing and implementing workflows, procedures, and systems for third party enrollment for new and existing physicians with critical internal controls and performance metrics.
• Responsible for the supervision, training, and coordination of day-to-day activities of Provider Enrollment staff, and project management of related tasks.
• Oversee the processing of provider enrollment applications and renewals for licensed independent providers who perform professional billing through BUMG/FPF.
• Must remain current regarding regulatory requirements for NCQA, health plans, and other applicable agencies, and ensure staff adherence to relevant guidelines to maintain compliance.
• Participate in audits conducted by the agencies and payors to measure the Enrollment Office compliance rate.
• Participate in review of credentialing billing denials and remediating root cause as it relates to enrollment issues.
• Maintain policies and procedures and assist the Associate Director in development of new policies as necessary, to comply with regulatory requirements.
• Provides back up to the Associate Director as needed, and may perform duties of Enrollment Coordinator to support department operations.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required)

JOB REQUIREMENTS

REQUIRED EDUCATION AND EXPERIENCE:

Associates degree preferred, or equivalent experience required

Minimum of 7 years of payer enrollment experience in a hospital or office-based setting

PREFERRED EDUCATION AND EXPERIENCE:

Bachelor’s degree preferred

Supervisory experience preferred

CERTIFICATIONS, LICENSES, REGISTRATIONS REQUIRED:

N/A

CERTIFICATIONS, LICENSES, REGISTRATIONS PREFERRED:

N/A

KNOWLEDGE, SKILLS & ABILITIES (KSAs):

• Working knowledge of provider enrollment, and understanding of the hospital credentialing and privileging
• Knowledge of billing processes a plus
• Ability to work well with all levels of personnel.
• Ability to provide direction and development to employees by coaching, identifying training needs, assigning progressively challenging projects, and assisting in career development planning.
• Strong organizational skills required to keep a very large and complex system running efficiently and effectively
• Strong problem solving skills needed to resolve any problems as they arise.
• Must have proven ability to maintain sensitive and confidential information.
• Proficient with standard software used in healthcare settings (i.e. MS Office products) and ability to learn new software. Strong skills in Access a plus.
• Able to function independently and perform routine department procedures without supervision.

JOB BENEFITS:

• Competitive pay
• Full suite of benefits for eligible part-time/full-time employees
• Health benefits includes a FREE medical plan option
• 33 PTO days with carry-over
• Discounted parking and commuter benefits
• Supportive work environment with a focus on training, professional development, and growth
• Highly subsidized medical, dental, and vision insurance options
• Access to Pathways, a leadership acceleration program increasing inclusion and diversity at the leadership level across Boston Medical Center Health System
• Tuition reimbursement and tuition remission programs

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE : This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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