Provider Enrollment Specialist

Eye Care Partners•Ballwin, MO

33d•$26 - $28

About The Position

The Provider Enrollment Supervisor is responsible for providing supervision and structure for the department's daily operations and functions. The supervisor works to ensure department productivity and quality standards are met or exceeded by coordinating staff and developing efficient workflows. The supervisor guides the staff in their day-to-day responsibilities, including mentoring and training the staff as needed. Must be proficient in facilitation and interpersonal communication, demonstrating skills in organization, prioritization, professionalism and coaching others. This position works with and supports Managed Care, Revenue Cycle, Finance, Treasury and both internal and external customers in various regions to execute tasks related to new payer enrollments. The Supervisor is a representative of the Provider Enrollment Dept and supports internal business partners in all aspects of initial credentialing and re-credentialing of ASCs with various Payor Plans, Government Agencies and State Agencies. Processes and monitors initial and renewal applications for ASCs/facilities. Communicates with ASCs, Contract Managers and Regional Directors regarding payer application processing, the collection of all required documentation; submission to payers and distributes approval documentation. Maintains accurate, organized, and current files and databases; documents all work efforts in department's task workflow system; assists when needed in audits performed by regulatory and accrediting agencies, Department of Health, managed care organizations/payers, and others; and functions as managed care liaison, advisor and resource person for ASC administrators, business office staff, and other leadership personnel.

Requirements

4 Year BA Degree or 4 Years of Equivalent Experience
HS Diploma
3+ years of experience in managed care environment (with either payer or provider)
Detailed understanding of Medicare, Medicaid, and Managed Care Plan payors, products, and regulations
Knowledge of CMS I&A, NPPES & the ability to update as necessary
Knowledge of Revenue Cycle operations as it applies to investigating & resolving denials when related to Provider Enrollment
Ability to perform essential job function with high degree of independence, flexibility, and creative problem-solving techniques
Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
Goal Driven with a firm understanding of credentialing department KPIs.
Detail oriented, professional attitude, reliable
Management and organizational skills to support the leadership of this function
Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
Interpersonal skills to support customer service, functional, and teammate support needs
Able to communicate effectively in English, both verbally and in writing
Ability for intermediate problem solving, including mathematics
Intermediate to Advanced computer operation
Proficiency with Microsoft Excel, Word, PowerPoint and Outlook
Specialty knowledge of systems relating to job function
Payor Portal platforms (PECOS, Availity, State Medicaid)
Credentialing platforms, related software, and websites (NPPES, CAQH, etc.)
Adobe Pro (Editor applications)
Knowledge of state and federal regulations for this position; functional understanding of HIPAA guidelines

Nice To Haves

Experience in the completion of payer facility credentialing applications and an understanding of required facility credentials/licenses strongly preferred

Responsibilities

Process initial and re-credentialing ASC payer applications for Government (Medicare/ Medicaid), Commercial and Medicaid/Medicare replacement payers
Correspond with ASC administrators, business office teams and contract team (Contract Managers and Regional Directors of Managed Care) regarding credentialing needs, status of provider files, or any other questions that arise. Notifies teams when actions are completed.
Lead provider credentialing and provider enrollment efforts.
Monitor department metrics
Train staff and create new training documents
Identify and communicate trends and resolutions
Assist in guiding workflow assignments
Manage projects to ensure deadlines are met
Support providers, offices, and other shared services with enrollment needs
Develop and maintain positive working relationships with team members and payer representatives
Credential providers to be in network with insurance plans
Organize provider information for multiple practices
Communicate closely with providers and offices regarding credentialing
Oversee and facilitate follow up with insurance companies regarding network status on an as needed basis
Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements
Attend collaborative meetings • Partner with staff to resolve any challenges they are having
Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
Performs other duties that may be necessary or in the best interest of the organization