Provider Enrollment Specialist

American Vision Partners; Tempe (AZ); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Medical and dental insurance

Eye care discounts

Child care assistance

Pet insurance

Continuing education funds

401(k) plan

Paid holidays

PTO and Sick Time

Growth opportunities

Job summary

American Vision Partners (AVP) seeks a Provider Enrollment Specialist to support enrollment applications for practitioners and facilities and to assist in credentialing processes.

The role involves managing enrollments, maintaining portals and logs, and ensuring compliance with HIPAA, NCQA, Medicare and Medicaid standards.

Qualifications

• High School Diploma or equivalent.
• Associate's Degree preferred or 2 years of office experience in lieu.
• Provider Enrollment Specialist Certificate (PESC) or Certified Provider Credentialing Specialist (CPCS) or similar certification in credentialing, health plan or network management required
• 2–3 years’ experience in Provider Enrollment and Credentialing fields is required
• Must have working knowledge in Managed Care and/or Network Management
• Proficiency in MS applications including credentialing database software
• Strong organizational skills and attention to detail
• Excellent communication and problem solving abilities within a team environment
• Ability to work independently and prioritize assigned duties
• Ability to establish and maintain effective working relationships with insurance representatives, providers and coworkers

Responsibilities

• Prepares and submits enrollment applications for practitioners/group practices and facilities
• Initiates and manages new enrollments until providers are enrolled with all assigned payers
• Follows up on the status of enrollment applications and maintains updated data using Smart Sheets
• Keeps detailed log of all pending and completed tasks using Smart Sheets
• Maintains/updates enrollment status reports and updates regularly
• Maintains/updates Wybtrak/CAQH and other provider portals regularly
• Maintains managed care insurance paperless files for assigned practitioners
• Contacts practitioners, insurance representatives and provider staff for data compilation
• Complies with NCQA, Medicare and Medicaid standards and department procedures
• Maintains confidentiality and adheres to HIPAA guidelines/regulations
• Familiar with Medicare, Medicaid, commercial fee schedules; assists in updating fee schedules for Next Gen EPM
• Works to resolve issues proactively
• Performs all other duties as assigned

Skills

MS Office

Organizational skills

Communication skills

Problem solving

Independence

Education

Associate's Degree preferred

2+ years office experience in lieu of degree

Credentialing certification (PESC/CPCS)

Tools

Credentialing databases

Job description

At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers.

At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees!

Overview

As a Provider Enrollment Specialist, you'll be responsible for assisting with the administration of the provider enrollment process for assigned new and existing providers. You'll also be responsible for assisting in obtaining and maintaining information essential to complete the credentialing/re-credentialing process.

Responsibilities

• Prepares and submits enrollment applications for practitioners/group practices and facilities
• Initiates and manages new enrollments until providers are enrolled with all assigned payers
• Follows up on the status of enrollment applications as well as maintaining all updated needed using Smart Sheets
• Using Smart Sheets, keeps detailed log of all pending and completed tasks
• Maintains/Updates/Communicates enrollment status reports and updates on regular basis
• Maintains/updates Wybtrak/CAQH and other provider portals on regular basis
• Maintains managed care insurance paperless files for assigned practitioners
• Frequently contacts practitioners, insurance representatives and other provider staff for compilation of provider data
• Complies with NCQA, Medicare and Medicaid standards, department procedures and guidelines
• Maintains strict confidentiality, adheres to all HIPAA Guidelines/Regulations
• Familiar with Medicare, Medicaid, commercial fee schedules; assist Director in updating fee schedules for updates to Next Gen EPM
• Works effectively and proactively to resolve issues
• Performs all other duties as assigned

Qualifications

• High School Diploma or equivalent
• Associate's Degree preferred or - 2 years of office business experience in lieu of Associate Degree
• Provider Enrollment Specialist Certificate (PESC) or Certified Provider Credentialing Specialist (CPCS) or similar certification in credentialing, health plan or network management required
• 2 – 3 years’ experience in Provider Enrollment and Credentialing fields is required for this position
• Must have working knowledge in Managed Care and/or Network Management
• Proficiency in MS applications including and not limited to credentialing database software
• Strong organizational skills and ability to pay attention to detail
• Excellent communication skills and problem solving abilities within a team environment
• Ability to work independently and prioritize assigned duties within given time frames
• Ability to establish and maintain effective working relationships with insurance representatives, providers and coworkers

Benefits & Perks

Your health, happiness and your future matters! At AVP, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!