Provider Enrollment Analyst
Location: Steward Health Care Network
Posted Date: 5/24/2023
Reporting to the Director Provider Enrollment & Credentialing, the Provider Enrollment Analyst manages the accurate and efficient data of SHCN providers with health plan contracts.
- Coordinates all operational aspects of maintaining accurate SHCN provider data with SHCN-contracted managed care health plans working closely with other SHCN Managers, SHCN Provider Enrollment, and network representatives. Specifically, the Provider Enrollment Analyst is responsible to: manage, reconcile, and analyze SHCN provider data for accurate and continuous maintenance with SHCN and contracted health plans.
- Develop close and collaborative working relationships with provider and local chapter offices to streamline the accurate submission of information to the health plans and to SHCN. Work closely with SHCN, its affiliates, and the health plans to reconcile any differences in listings of enrolled SHCN physicians. Coordinates these efforts with and through the local chapter offices and SMG Provider Enrollment and works with SHCN Analytic Team to implement changes in provider data.
- Conducts ongoing audit of the process to ensure accuracy of provider data. Ensure that SHCN has an accurate and up-to-date listing of all employed and SHCN affiliated physicians at all times and that each of the contracted health plans does as well.
- Identifies opportunities for improvements in the process and develops strategies to implement appropriate changes and enhancements.
- Develops partnerships with relevant staff at the health plans in coordinating enrollment of SHCN providers and independently troubleshooting issues as they arise.
- Maintain ongoing participation in cross-training activities.
- Actively engage in addressing special projects as they arise, conducting preliminary research and follow-up, and tracking/monitoring to facilitate ongoing reporting of project status. Provides valid feedback to the Director Provider Enrollment & Credentialing on departmental issues and progress.
- Perform other functions as assigned.
Years of Experience:
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Job Status: Full Time
Job Reference #: 130691