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.

The Senior Provider Enrollment Representative assists the Provider Enrollment Supervisor in coordination of all day to day operations for the Department. Monitors daily inventory, assigns work, and assists with preparation of performance reports. Handles identification and resolution of complex data issues in conjunction with IT staff. Monitors process for contract counter execution. Assures the accuracy of newly loaded data for existing and new providers into Onyx, and for accuracy of changes due to implementation of data cleanup projects related to payment and compliance. Primary staff responsible for terminations notifications in compliance with NCQA, MassHealth, Connector, and New Hampshire regulations.

Our Investment in You:

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

Key Functions/Responsibilities:

• Coordinates the day to day activities of the Provider Enrollment staff, assuring timely inventory management in the absence of the Supervisor in order to meet department turnaround time goals
  • Generates and monitors inventory reports daily
• Implements all aspects of provider enrollment to ensure provider hierarchy and data are loaded appropriately in all relevant systems
  • This includes understanding and communicating unique arrangements and ensuring the Plan accurately enrolls the providers with those arrangements
• Assists with compilation of productivity and quality results
  • May assist with identifying and addressing productivity or performance issues
• Assists Quality Assurance and Training Manager in the training of new staff on department system, policies, and procedures
• Works with Provider Relations and Contracting staff to implement new contracts
  • Oversees data entry accuracy of large scale contract changes
• Responsible for monitoring the contract counter execution process to assure compliance with turnaround time goals
• Identifies and implements Department data cleanup efforts related to provider payment issues, and presentation in the Provider Directory
• Develops, sends, tracks, resolves complex IT ticket requests to assure proper payment assignment
• Generates a standard set of reports for Department to assure data integrity, including but not limited to common data issues to support correct provider payment and data accuracy of the Provider Directory
• Analyzes and proposes solutions on provider data issues as required
• Other duties as assigned by supervisor

Qualifications:

Education:

• Bachelor’s degree in Business Administration or related field or equivalent combination of training and experience

Experience:

• 2 or more years business experience in a managed care or healthcare setting
• 2 or more years of progressively responsible Provider Relations and/or Provider Enrollment experience and/or demonstrated ability to perform responsibilities of position

Competencies, Skills, and Attributes:

• Demonstrated competence using Microsoft Office products especially Excel and Access; familiarity with FACETS and/or Onyx preferred
• Proven demonstration of effective communication skills (verbal and written), and interpersonal skills to lead and direct the efforts of others, both internally and externally
• Ability to be flexible and work independently
  • Ability to manage multiple tasks and possess excellent organizational skills

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, 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.

Required Skills

Required Experience