Provider Enrollment Analyst
About the role
The Provider Enrollment analyst at NorthBay Health is responsible for all Medical Staff and Allied Health Practitioner (AHP) health plan credentialing and recredentialing with government and commercial health plans. The position also enrolls, credentials, and terminates NorthBay physicians/providers with NorthBay's contracted health plan partners.
Responsibilities
- Enroll, credential, and terminate providers and select contracted specialists.
- Serve as a resource in credentialing standards for NCQA, CMS, Medi-Cal, medical group affiliates and health plans.
- Maintain rosters and functionality that support a compliant provider enrollment process.
- Compile and distribute periodic reports, both within the department and throughout the organization.
- Investigate and resolve provider enrollment issues.
- Service as a resource related to the National Committee for Quality Assurance (NCQA).
Requirements
- Minimum 5 years of experience in a corporate business setting, preferably in a health care setting.
- Advanced computer skills to include: Microsoft Windows and Office suite, Access, MD Staff, Tableau and other on-line enrollment systems.
- Teaching ability and the ability to efficiently collaborate with others.
- Capable of communicating effectively at all levels of the organization.
- Able to work on multiple projects simultaneously and manage deadlines.
- Highest level of organizational skills with the ability to set priorities, work independently and be an effective team member.
- Ability to integrate information from multiple sources into an automated process to effectively manage provider health plan enrollment.
Qualifications
- Advanced computer skills to include: Microsoft Windows and Office suite, Access, MD Staff, Tableau and other on-line enrollment systems.
- Teaching ability and the ability to efficiently collaborate with others.
- Capable of communicating effectively at all levels of the organization.
- Able to work on multiple projects simultaneously and manage deadlines.
- Highest level of organizational skills with the ability to set priorities, work independently and be an effective team member.
- Ability to integrate information from multiple sources into an automated process to effectively manage provider health plan enrollment.
Skills
- Pecos
- Pave
- Caqh
- Better Doctors
- MD-Staff
Benefits
- Medical, dental, and vision insurance
- Life, disability, and long-term care coverage
- Paid time off including vacation, sick leave, holidays, and bereavement
- A 403(b) retirement plan with employer match
- Education reimbursement for eligible roles
- Professional development and training programs
- Employee Assistance Program
- Wellness programs
- Recognition programs
- Shift differentials
- Market-based compensation review and increases subject to approval and organizational performance
Pay
Compensation structure includes a step-based system (Steps 1–5) based on years of directly related experience, with Step 5 representing 20 or more years of experience in the role. Manager level and above positions are paid a fixed annual base salary and are eligible for a variable incentive compensation plan. Physician compensation is structured based on specialty and role requirements.
Schedule
This is not a remote position. Hybrid position requires 2 days days on-site, 3 days remote. Hours of Work: Non-exempt. Normally works eight-hour day. Hours will vary according to work demands and project requirements.