It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Responsible for accurate set up of provider records in order to assure proper payment for providers. Handles all implementation steps to enroll providers in the Plan to ensure timely access for members and accurate payment for providers.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Manages the interaction with providers and office managers to ensure that all necessary information is collected and analyzed so providers can be credentialed and loaded in the system accurately according to department standards
• Enters the provider data once the data are validated for accuracy so that providers are paid correctly from the beginning of their affiliation with the Plan
• Acquires and demonstrates a thorough knowledge of the unique arrangements and ensures the Plan enrolls providers with those arrangements
• Independently initiates oversight of existing provider record problems. Identifies system problems with provider set up and facilitates resolution so that provider payments are accurate
• Coordinates set up and hand off of provider records to Credentialing Department. Completes provider data input and assures data forms are completed per WellSense Health Plan requirements
• Reviews submitted application and supporting documentation to ensure the data captured through the enrollment process is in compliance with NCQA, applicable state requirements
• Follows established contracting process to ensure the smooth implementation of the provider contracts. Tracks, maintains and communicates information pertaining to the status of contracts in accordance with the established contracting process
• Researches, facilitates and assists with resolution of interdepartmental issues related to enrollment as identified by providers and internal WellSense Health Plan staff
• Maintains the integrity of Provider Data in Onyx. Provides assistance with ongoing quality initiatives related to improved data processing and workflows
• Provides system analysis support as needed to ensure operational compliance with Plan provider and database rules
• Develops basic reports in Onyx in order to provide and communicate information

Qualifications:

Education:

• Bachelors degree or an equivalent combination of education, training and experience is required

Experience:

• 2 or more years business experience in a managed care or healthcare setting is required

Competencies, Skills, and Attributes:

• Ability to work as a team member, to manage multiple tasks, to be flexible, and to work independently and possess excellent organizational and problem solving skills
• Ability to accurately enter, proof, submit data and to identify inaccurate data and process to resolution
• Demonstrated competence using Microsoft Office products especially Word, Excel, Outlook, Access, PowerPoint Experience or knowledge of ONYX, FACETS and/or similar provider data and/or claims processing system
• Effective communication skills (verbal and written)

Working Conditions and Physical Effort:

• Ability to work OT during peak periods

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

• WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.