Enrollment Representative

Reports to the Supervisor, Provider Enrollment & Credentialing . Responsible for the timely completion of all initial and re-credentialing processes, as well as payer enrollments, for Beacon Health System . Coordinates with physicians, providers, credentialing agencies, regulatory bodies, payors, office managers, and contracted providers to ensure credentialing and enrollment activities comply with National Committee on Quality Assurance (NCQA) standards and departmental policies and procedures.

MISSION, VALUES, AND SERVICE GOALS

MISSION : We deliver outstanding care, inspire health, and connect with heart.

VALUES : Trust. Respect. Integrity. Compassion.

SERVICE GOALS : Personally connect. Keep everyone informed. Be on their team.

Primary Responsibilities

Credentialing

• Ensures timely completion of credentialing activities in compliance with NCQA and departmental standards.
• Coordinates with external agencies, payors, office managers, and contracted providers to complete credentialing requirements.
• Acts as a liaison with Medical Directors, Hospital Medical Staff, and internal / external stakeholders regarding credentialing status.
• Performs Primary Source Verifications per applicable accreditation standards (JCAHO, AAAHC, URAC, etc.).
• Conducts online verifications and reviews relevant credentialing resources.
• Notifies appropriate entities of provider effective and termination dates.
• Communicates with the Physician Recruitment team regarding provider onboarding and credentialing status.
• Maintains regular follow-up with providers and communicates status updates to ensure credentialing completion prior to start dates.

Enrollment

Organizational Responsibilities

Education and Experience

Knowledge and Skills

Working Conditions

Physical Demands