Provider Enrollment Specialist

Eye Care Partners•Ballwin, MO

2d•Remote

About The Position

EyeCare Partners is seeking an experienced Provider Enrollment Specialist familiar with provider data management and credentialing. The position manages multiple enrollments and competing priorities while supporting the Supervisor of Provider Enrollment. The role is remote and applicants must 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 a driving record meeting company liability carrier 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.
Professional appearance and conduct.
Logical and critical-thinking skills for problem solving and analysis.
In-depth knowledge of performance metrics.
Customer-focused, with excellent written, listening, and verbal communication skills.
Ability to manage calls, de-escalate issues, and reassure callers that resolutions will be pursued.
Ability to work effectively under stress and conflicting demands while meeting deadlines.
Detail-oriented, reliable, and professional attitude.
Flexible, positive attitude toward changing work assignments and priorities; meets attendance and punctuality expectations.
Management and organizational skills to support leadership of the function.
Ability to follow and provide verbal and written instructions, with adequate grammar and spelling to avoid mistakes or misinterpretations.
Interpersonal skills to support customer service, functional, and teammate needs.
Able to communicate effectively in English, verbally and in writing.
Basic to intermediate problem-solving ability, including mathematics.
Intermediate computer operation skills and proficiency with Microsoft Excel, Word, PowerPoint, and Outlook.
Knowledge of systems related to the job function.
Knowledge of applicable state and federal regulations and a general understanding of HIPAA guidelines.
Good understanding of insurance payers and enrollment methods.
Ability to diagnose and resolve basic enrollment issues.
Excellent organizational skills and initiative in accomplishing goals.
Ability to learn, grow, adapt, accept change, and create a positive, team-oriented work environment.
Ability to work overtime if required.

Responsibilities

Enroll providers with Medicare, Medicaid, commercial plans, MCOs, and other applicable payers.
Complete credentialing, recredentialing, and privileging documentation and applications for providers at assigned hospitals and facilities.
Serve as the first point of contact for internal office and provider requests.
Maintain provider credentialing databases and update applicable software and systems to keep enrollment data current.
Keep CAQH and NPPES information accurate and up to date.
Maintain ongoing contact with insurance payer representatives.
Communicate enrollment updates and issues to leadership.
Follow up weekly with payers on outstanding enrollments.
Maintain demographic changes for all providers.
Maintain provider hospital appointments and reappointments.
Maintain and renew provider expirables, including medical licenses, DEAs, board certifications, and malpractice insurance.