Provider Enrollment Specialist
About The Position
EyeCare Partners is seeking an experienced Provider Enrollment Specialist to manage provider data and credentialing in a growing eye care organization. The role manages multiple enrollments and competing priorities and provides support to the Supervisor of Provider Enrollment. It is remote and requires the employee to live in one of the listed states: Missouri, Florida, Kansas, Kentucky, Pennsylvania, Virginia, New Jersey, Texas, Minnesota, Michigan, Oklahoma, Alabama, North Carolina, Georgia, Illinois, Ohio, Indiana, or Arizona. Travel to other locations may be necessary; employees who travel must have dependable transportation and meet the company liability carrier’s driving-record standards.
Requirements
- High school diploma or GED.
- At least 2 years of related experience or training; an equivalent combination of education and experience will be considered.
- Good understanding of insurance payers and enrollment methods, with the ability to diagnose and resolve basic enrollment issues.
- Knowledge of state and federal regulations applicable to the position and a general understanding of HIPAA guidelines.
- Proficiency with Microsoft Excel, Word, PowerPoint, and Outlook; intermediate computer operation and specialty knowledge of systems relating to the job.
- Excellent written, verbal, listening, and social communication skills, including the ability to communicate effectively in English.
- Strong organization, management, and interpersonal skills to support customer service, leadership, and teammates.
- Logical and critical-thinking skills for problem solving and analysis, including basic to intermediate mathematics.
- Ability to manage conflicting demands and deadlines, maintain composure on calls, de-escalate issues, and build confidence in finding resolutions.
- Professional appearance and conduct; detail-oriented, reliable, and positive attitude.
- Ability to follow or provide verbal and written instructions using sufficient grammar and spelling to avoid mistakes or misinterpretations.
- Flexibility in accepting work assignments and priorities, willingness to learn new technologies and systems, and ability to adapt to change.
- Meets attendance and punctuality expectations; ability to work overtime if required.
- If travel is needed, dependable transportation and a driving record that meets company liability carrier standards.
- Must live in one of the following states: Missouri, Florida, Kansas, Kentucky, Pennsylvania, Virginia, New Jersey, Texas, Minnesota, Michigan, Oklahoma, Alabama, North Carolina, Georgia, Illinois, Ohio, Indiana, or Arizona.
Nice To Haves
- Desire to gain industry knowledge and training.
- Demonstrates initiative in accomplishing goals.
- In-depth knowledge of performance metrics.
Responsibilities
- Enroll providers with Medicare, Medicaid, commercial plans, and MCOs by supplying information to payers.
- Complete documentation and applications for provider credentialing, recredentialing, and privileging at assigned hospitals and facilities.
- Serve as the first point of contact for internal office and provider requests.
- Maintain the provider credentialing database and update applicable software and systems to keep enrollment data current.
- Keep CAQH and NPPES information accurate and current.
- Maintain contact with insurance payer representatives and follow up weekly on outstanding enrollments.
- Communicate enrollment updates and issues to leadership.
- Maintain provider demographic changes and hospital appointments and reappointments.
- Maintain and renew provider expirables, including medical licenses, DEAs, board certifications, and malpractice insurance.
- Support the leadership of the provider enrollment function and meet assigned deadlines and priorities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
