Enrollment Operations Coordinator (remote)

Dartmouth Health - Lebanon, NH

Full-time

Onsite - Lebanon, NH

Ambulatory Health Care Services

About the position

The Enrollment Operations Coordinator at Dartmouth Health is responsible for the coordination of provider enrollment, Epic SER access, and management of insurance-related claims. This role serves as a vital liaison between various departments including D-HH credentialing, D-H contracting, Conifer RMD, external payors, and facilities. The coordinator will enroll providers for network participation with both governmental and contracted commercial/managed Medicaid health plans, ensuring that all necessary documentation and processes are followed to facilitate smooth enrollment and claims management. In addition to enrollment tasks, the coordinator will assist in the development and maintenance of the credentialing database, entering new data and updating existing enrollment records. A significant part of the role involves reviewing claim work queues, conducting necessary research, and collaborating with appropriate parties to correct edits or address denials. The coordinator will manage the resolution of enrollment issues that affect the timely and accurate reimbursement of services, generating NCQA/delegated credentialing provider exclusion queries as needed. The position also requires the submission of provider demographics for initial Epic EMR access and the termination of inactive provider records. The coordinator will maintain various aspects of the Epic provider SER records, including demographics, billing, admitting, and departments/revenue routing. Additionally, the role involves maintaining electronic prescribing rights (EPCS) and state license data, tracking enrollment confirmations, and coordinating managed care audits. The coordinator will also assist with updates and changes that affect billing services, report on missing provider information, audit data for accuracy, and respond to DHSM tickets regarding provider access issues. Other duties may be assigned as required.

Responsibilities

• Serves as liaison between D-HH credentialing, D-H contracting, Conifer RMD, external payors and facilities.
• Enrolls providers for network participation with Governmental and contracted Commercial/ Managed Medicaid health plans.
• Assists in the development and maintenance of the credentialing database. Enters new data and updates existing enrollment records.
• Reviews claim work queues, conducts necessary research, and works with the appropriate parties to correct edits or address denials.
• Manages the resolution of enrollment issues relating to timely and accurate reimbursement of services.
• Generates NCQA/ delegated credentialing provider exclusion queries.
• Submits provider demographics for initial Epic EMR access and terminates inactive provider records.
• Maintains aspects of the Epic provider SER records, including but not limited to; demographics, billing, admitting, departments/revenue routing.
• Maintains electronic prescribing rights (EPCS) and state license data.
• Maintains, tracks, and enters enrollment confirmations into the credentialing database and Epic, controlling claims submission.
• Coordinates, schedules and participates in managed care audits. Reviews files prior to audit.
• Assists with updates and changes that affect how services are billed.
• Reports on missing provider information.
• Audits data to ensure accuracy for reporting to payers.
• Responds to DHSM tickets regarding provider access issues.
• Performs other duties as required or assigned.

Requirements

• High School diploma or the equivalent required.
• Minimum of two years healthcare experience required.
• Strong written and verbal interpersonal skills required.
• Must be detail oriented.
• Experience with CAQH is preferred.
• Experience with Epic is preferred.
• Demonstrated proficiency in word processing, spreadsheet software, database management and data entry preferred.

Nice-to-haves

• Experience with CAQH is preferred.
• Experience with Epic is preferred.