Office Support Specialist I

The Department of Public Health (DPH) at Tewksbury Hospital is looking for a Credentialing Office Support Specialist I to join its team.  This role is responsible for overseeing provider enrollment and access within the Centers for Medicare & Medicaid Services (CMS) Provider Enrollment, Chain, and Ownership System (PECOS) after clinicians have been credentialed and granted medical staff privileges. The Credentialing Office Support Specialist coordinates federal and state provider enrollment activities to ensure compliance with CMS and MassHealth requirements.

This position is Monday through Friday from 8am - 4:00pm

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Create and maintain individual provider enrollment accounts for Individual Provider Enrollment (CMS-855I) and Reassignment of Benefits (CMS-855R).

• Set up provider access and ensure accurate enrollment in the CMS/PECOS system.

• Enter and maintain provider demographics and practice location information.

• Process reassignment of benefits to the appropriate group practice.

• Upload and maintain all required credentialing and enrollment documentation.

• Coordinate and obtain provider approval signatures on enrollment applications and supporting documents.

• Collaborate with the Fiscal/Billing department to ensure accurate provider enrollment, reimbursement setup, and payer compliance.

• Coordinate MassHealth enrollment for non-billing providers, including assisting with individual provider contracts for Ordering, Referring, and Prescribing (ORP) providers.

• Monitor and ensure completion of required five-year revalidation for CMS and MassHealth provider enrollments to maintain active participation.

• Track enrollment application status, respond to requests for additional information, and resolve issues with CMS, MassHealth, and Medicare Administrative Contractors (MACs).

• Offboard departing clinicians by terminating or updating CMS and MassHealth enrollments, ending reassignment relationships, and removing applicable system access in accordance with organizational policies.

• Maintain accurate provider enrollment records and ensure compliance with federal, state, payer, and organizational credentialing standards.

• Assist with the coordination the DPH Practitioner’s Schedule for the Department of Medicine

• Takes minutes at Committee meetings and other meetings assigned

Required Qualifications:

• Ability to communicate effectively

• Ability to multi-task and prioritize

• Ability to assist customers of diverse backgrounds

• Knowledge of software applications such as desktop publishing, project management, spreadsheets, and database management.

   

Preferred Qualifications: 

• Knowledge of the laws, rules, regulations, policies, procedures, specifications, standards and guidelines governing assigned agency or unit activities.

• Knowledge of the types and uses of agency databases, documents and files.

• Knowledge of state laws, procedures, and guidelines.

About the Department of Public Health:

The mission of the Massachusetts Department of Public Health (DPH) is to prevent illness, injury, and premature death, to assure access to high-quality public health and health care services, and to promote wellness and health equity for all people in the Commonwealth.

We envision a Commonwealth in which all people enjoy optimal health. Massachusetts ranks among the healthiest states according to comparative analyses, but we face numerous challenges, including chronic and infectious disease, substance abuse, violence, preventable hospitalizations, and health disparities.

DPH coordinates programs and policies to address specific diseases and conditions and offers services to address the needs of vulnerable populations.  We also develop, implement, promote, and enforce regulations and policies to assure that the conditions under which people live are most conducive to health and enable people to make healthy choices for themselves and their families. We license health professionals, healthcare facilities and a variety of businesses that impact public health. We operate the state laboratory and four public health hospitals. We monitor health status and manage vital records including births, marriages and deaths. We educate people about public health issues and work closely with local boards of health and community partners to identify and solve public health problems.

More information can be found at: MA Department of Public Health

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

ADA Reasonable Accommodation:

If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests.

For questions regarding this requisition, please contact Executive Office of Health and Human Services, Human Resources at 1-800- 510-4122 Ext. # 4.