Provider Enrollment Specialist

Mdvip•Boca Raton, FL

10d

About The Position

MDVIP is seeking a Provider Enrollment Specialist, reporting to the Manager of Insurance Programs, to manage the insurance provider enrollment process for our MDVIP physician affiliates. This role requires a deep understanding of credentialing & contracting procedures and the ability to provide accurate guidance and support to affiliated physicians, physician staff and internal teams. If you have a thorough understanding of managing provider enrollment and are a critical thinker, we want to meet you. You’ll coordinate with and support the Insurance Services Department in the resolution of complex or advanced issues and cases. As the Provider Enrollment Specialist, you’ll serve as a liaison between MDVIP and insurance carriers, commercial and federal clearinghouses, and regulatory bodies at the state, county, and federal levels. Additionally, you will ensure compliance with all licensing and credentialing requirements on behalf of MDVIP affiliated physicians.

Requirements

Successful track record in a similar corporate role focused on coordination or management of provider enrollment.
Interprets complex data using experience and critical thinking to support insights.
Builds collaborative, productive relationships with physicians, physician staff and stakeholders.
Communicates clearly, professionally, and effectively across diverse audiences.
Proactively identifies solutions, pursues growth, and seeks added responsibility.
Demonstrates accountability, meets deadlines, and maintains daily preparedness.
Applies strategic thinking to assess risks, trends, and opportunities for informed decision-making.
Associate’s degree and at least two (2) years related business experience
Four (4) years of related work experience.
Familiarity with EMR and credentialing software.
Proficient in Microsoft Office applications.

Nice To Haves

Experience with CAQH, PECOS & NPPES applications.
Experience with Net Docs, credentialing software, and athena.
Certified Provider Credentialing Specialist (CPCS).
Certified Provider Enrollment Specialist (CPES).
Experience with Salesforce or other CRM tools.

Responsibilities

Coordinate all aspects of the provider enrollment process while delivering top quality customer service.
Maintain provider enrollment system processes, policy and procedures, ensuring adherence to all requirements and taking corrective steps as needed.
Serve as a liaison between physicians, physician staff, MDVIP staff, and external entities—including insurance carriers, clearinghouses, and licensing agencies—to support all aspects of the credentialing & contracting process.
Identify pertinent matters and provide analysis and resolution to Management weekly.
Establish and communicate timelines with MDVIP affiliates to ensure schedules are met. Work directly with stakeholders to overcome roadblocks.
Prepare, review, and send status reports to affiliated physicians and field staff, follow-up to ensure closure on outstanding cases.
Create and communicate physician provider enrollment status reports to internal Management in monthly meetings.
Compile, run, and complete various insurance related reports and presentations for Management.
Assess all provider enrollment related materials and reports, and coordinate with external stakeholders to verify all outside processes are completed.
Provide analysis and recommendations to Management for escalated transition issues. Resolves escalated issues and assists with urgent requests. Provide training and guidance to affiliates, physician staff or respective billing companies related to MDVIP, when requested, on preventive billing protocols and/or provider enrollment needs