Exemption Status:
Exempt
Hiring Range:
$59,051.20 - $106,308.80
Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.
Schedule Details:
Monday through Friday
Scheduled Hours:
7:00 AM - 3:30 PM
Shift:
1 - Day Shift, 8 Hours (United States of America)
Hours:
40
Cost Center:
99940 - 6612 Medical Staff Admin
This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.
Everyone Is a Caregiver
At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.
Responsible for the efficient management of UMMHC provider enrollment process with third-party insurance plans that are under contract with UMMMG. Interacts extensively with physicians, insurance plans and clinical divisions and departments to facilitate provider enrollment and to maximize reimbursement for services rendered.
Major Responsibilities:
- Negotiates and resolves issues on a day-to-day basis between UMMHC and third-party insurance plans in securing provider enrollment status for UMMMG employed providers as well as issues with claims payment and insurance plan credentialing.
- Resolves any coverage or billing issues between Central Business Office and third-party insurance plans as well as between the Managed Care Network Office and third-party insurance plans that cannot be resolved by the Provider Enrollment Specialists. Researches reimbursement claim problems and negotiates with insurer to reverse claim denials related to physician enrollment.
- Serves as liaison to providers, Central Business Office, UMMHC and UMass Memorial Medical Group staff, , and managers of various clinical departments and divisions on all provider enrollment-related issues such as enrollment requirements, status of applications, billing requirements, contract billing area assignments, provider effective dates, status changes, changes in panel status, changes in practice location, new or terminating enrollment, and unique enrollment issues affecting physicians. Recommends possible solutions on how problems might be mitigated.
- Prepares and generates a variety of reports from various databases regarding billing, panel and enrollment status of applicants, due diligence reports, change reports, provider directories, etc.
- Supervises revalidation- process for provider enrollment with managed care plans (each practitioner once every two years per plan). Ensures the timely and accurate submission and completion of all documents. Follows up with managed care plans on status of pending applications.
- Maintains a proficient working knowledge of the requirements for enrollment and contracting with all insurance plans currently under contract with UMMHC for the Medical Group.
- Recommends policies and procedures for the provider enrollment processes to Medical Staff Services Director and identifies areas of the processes that need improvement and recommends corrective procedures.
- Trains staff in enrollment, contractual, renewal procedures, and issues related to the application process for providers to ensure they are appropriately enrolled providers with numerous insurance plans.
- Responsible for training staff in the use of various databases which support and maintain provider billing information (Databases include Echo provider enrollment section, IDX Provider, Referring, Meditech Crossmap, and Radiology Crossmap).
Position Qualifications:
License/Certification/Education:
Required:
- Bachelor’s degree in Business, Health Care Management, or related discipline.
Preferred:
- National certification as CMSC (Certified Medical Staff Coordinator) or CPCS (Certified Provider Credentialing Specialist) desired, or willing to pursue and maintain certification.
Experience/Skills:
Required:
- Three to five years of experience in Provider Enrollment.
- Minimum 3 years supervisory experience.
- Must possess good negotiation skills and strong oral and written communication skills.
- Requires excellent computer skills to access and use multiple data systems.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.
As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.
If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.