Dartmouth Health - Lebanon, NH
posted 3 months ago
The Enrollment Operations Coordinator at Dartmouth-Hitchcock is a pivotal role responsible for overseeing the coordination of provider enrollment, managing Epic SER access, and handling insurance-related claims management. This position serves as a crucial liaison between various departments, including D-HH credentialing, D-H contracting, Conifer RMD, external payors, and facilities. The coordinator will play a key role in ensuring that providers are enrolled for network participation with both governmental and contracted commercial/managed Medicaid health plans. In addition to enrollment responsibilities, the coordinator will assist in the development and maintenance of the credentialing database, ensuring that new data is entered and existing enrollment records are updated accurately. The role involves reviewing claim work queues, conducting necessary research, and collaborating with relevant parties to correct edits or address denials, thereby managing the resolution of enrollment issues that affect timely and accurate reimbursement for services rendered. The coordinator will also generate NCQA/delegated credentialing provider exclusion queries, submit provider demographics for initial Epic EMR access, and terminate inactive provider records. Maintaining aspects of the Epic provider SER records, including demographics, billing, admitting, and departments/revenue routing, is essential. Furthermore, the coordinator will track and enter enrollment confirmations into the credentialing database and Epic, ensuring control over claims submission. The role includes coordinating, scheduling, and participating in managed care audits, reviewing files prior to audits, and assisting with updates and changes that impact billing services. The coordinator will report on missing provider information, audit data for accuracy in reporting to payers, respond to DHSM tickets regarding provider access issues, and perform other duties as required or assigned.