What are the responsibilities and job description for the Enrollment Operations Coordinator - Hybrid position at Dartmouth Health?
Responsible for the coordination of D-HH provider enrollment, Epic SER access, and insurance related claims management.
- 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.
- Maintain 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 effect 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.
- 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.
- None