Provider Enrollment Specialist

American Vision Partners; Tempe (AZ); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical and dental insurance

Eye care discounts

Child care assistance

Pet insurance

Continuing education funds

401(k)

Paid holidays

PTO

Sick Time

Opportunities for growth

Job summary

American Vision Partners (AVP) is seeking a Provider Enrollment Specialist to manage enrollment/credentialing for providers and practices. You will submit applications, track statuses, and maintain detailed records across payers.

The role requires 2–3 years of enrollment/credentialing experience, relevant certifications, strong organization, and familiarity with NCQA, Medicare, Medicaid, and carrier portals. AVP offers growth and comprehensive benefits.

Qualifications

• High School Diploma or equivalent required.
• Associate's Degree preferred or 2 years of office experience.
• PESC or CPCS certification or equivalent in credentialing required.
• 2–3 years of Provider Enrollment and Credentialing experience.
• Working knowledge of Managed Care/Network Management.
• Proficiency with credentialing databases and MS Office.
• Strong organization, attention to detail, and communication skills.

Responsibilities

• Prepares and submits enrollment applications for practitioners, group practices, and facilities.
• Initiates and manages new enrollments until providers are enrolled with all payers.
• Follows up on enrollment status and maintains logs using Smart Sheets.
• Maintains/updates enrollment status reports and provider portals (Wybrak/CAQH).
• Complies with NCQA, Medicare, Medicaid standards; HIPAA compliance.
• Contacts practitioners, insurance reps, and provider staff to assemble data.

Skills

Communication

Problem solving

Organizational skills

Independence & time management

Managed Care knowledge

Provider Enrollment experience

Education

High School Diploma or equivalent

Associate's Degree preferred

2 years office experience in lieu of degree

PESC or CPCS certification

Tools

MS Office & credentialing software

Job description

Company Intro

AtAmerican 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!