Brigham and Women’s Hospital
About the Role
Title: Revenue Analyst II, Provider Enrollment
Type; Remote
Location: Somerville United States
Job Description:
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
This role is supporting Provider Enrollment Delegation
Responsibilities Include, but not limited to:
1. Ensure required data fields are being pulled correctly from system and transmitted electronically to contracted health plans that delegate provider credentialing responsibilities to Mass General Brigham.
2. Work with IT Support team to build complex reports that meet health plan requirements.
3. Ensure MGB is compliant with weekly, monthly, quarterly payer reporting requirements ongoing
4. Work with various MGB enrollment teams to educate and ensure provider enrollment data is consistent across MGB network
5. Follow-up with health plans to troubleshoot enrollment / claim issues and identify process improvements
6. Ability to compare rosters between health plans and MGB to proactively identify discrepancies
7. Work with Health plans and MGB credentialing team to track and satisfy annual audit requirements and ensure compliance with NCQA
8. Excellent critical thinking skills and attention to detail.
Systems Used:
MD Staff / Applied Statistics Management (ASM) is Vendor
Epic
Excel
Adobe Pro
Job Summary
Summary: Reporting to the Senior Manager of Revenue Cycle Enrollment, the Analyst will be responsible for delegated enrollment with payers to ensure compliance and billing readiness while maintaining oversight of enrollment files. This role will also assist with enrollment processes including delegated contracts, roster updates/assessments, operational analysis, and report monitoring to identify opportunities for workflow improvements. The Analyst will provide analytical and project management support, offering recommendations to enhance operational efficiency and enrollment processes.
1. Oversee delegated credentialing and enrollment functions, ensuring adherence to payer requirements and regulatory guidelines.
2. Maintain and update enrollment files, provider directories, and delegated rosters in accordance with payer contracts and organizational policies.
3. Identify areas of improvement for standardization of enrollment data and documentation of enrollment related activities.
4. Perform root cause analysis to identify deficiency trends in the facility and delegated enrollment process.
5. Develop and maintain a working knowledge of all core systems (Epic) and ancillary systems (MD Staff, iPort, etc.)
6. Review avoidable write-off trends and identify & implement opportunities to reduce avoidable write-offs
7. Act as a liaison between Revenue Cycle Enrollment, payers, and internal stakeholders to streamline facility and delegated enrollment processes.
8. Serves as the department contact for facility enrollment and delegated enrollment with requests and questions.
9. Collaborates with other Revenue Cycle Operations staff, Compliance, CCO, Contracting, Digital, and any other departments required for enrollment initiatives.
10. Monitor, track, and report on enrollment timelines, identifying delays and implementing process improvements to enhance efficiency.
11. Assist in developing and maintaining enrollment workflows, policies, and procedures for facility and delegated enrollment functions.
12. Provide support for audits and ensure all enrollment-related documentation meets payer and regulatory requirements.
13. Participate in payer meetings and contract negotiations to advocate for streamlined facility and delegated enrollment processes.
14. Support special projects related to enrollment, including system integrations, policy updates, and process enhancements.
Qualifications
Education
Bachelor’s Degree Finance preferred
Can this role accept experience in lieu of a degree?
Yes
Licenses and Credentials
Experience
Experience in payer enrollment functions preferred. 2-3 years preferred.
Knowledge, Skills and Abilities
– Excellent analytical skills and attention to detail.
– Excellent communication skills and ability to effectively present data to revenue management and external department leaders.
– Self-motivated, self starter, and needs to be able to work independently. Resourceful and able to take initiative; take-charge ability, including knowledge of resources to answer questions and find required data and information
– Must be extremely well organized and have solid time management skills in order to handle multiple tasks simultaneously under sometimes tight deadlines
Additional Job Details (if applicable)
Remote Type
Remote
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.