Provider Enrollment Specialist

Job Title: Provider Enrollment Specialist

MUST LIVE IN ONE OF OUR 18 States: Missouri, Florida, Kansas, Kentucky, Pennsylvania, Virginia, New Jersey, Texas, Minnesota, Michigan, Oklahoma, Alabama, North Carolina, Georgia, Illinois, Ohio, Indiana, Arizona 

 

Job Summary

Our growing eye care organization has an immediate need for an experienced Provider Enrollment Specialist who is familiar with provider data management and credentialing. A successful individual in this role will manage multiple enrollments and priorities while providing support to the Supervisor of Provider Enrollment. 

Duties and Responsibilities

• Enroll providers with payers by providing information to the payers as applicable. This includes Medicare, Medicaid, commercial plans, and MCOs. 
• Complete required documentation and applications for credentialing, recredentialing and privileging providers at assigned hospitals/ facilities. 
• Serve as the first point of contact for internal office and provider requests.   
• Maintain a database for provider credentialing and update the applicable software/ systems as needed to ensure all provider enrollment data is up-to-date and current.  
• Keep CAQH updated with accurate and current information.  
• Keep NPPES updated with accurate and current information.  
• Maintain constant contact with insurance payer representatives.  
• Communicate effectively any enrollment updates and issues to leadership.  
• Follow up with payers on outstanding enrollments on a weekly basis.  
• Maintain all demographic changes for all providers. 
• Maintain all hospital appointments and re-appointments. 
• Maintain and renew provider expirables (medical license, DEAs, board certification, malpractice insurance, etc.). 

 

Education: 

High School Diploma or GED Required

 

Experience Requirements

• 2+ years of related experience or training, equivalent combination of education and experience will be considered

 

Knowledge, Skills and Abilities Requirements

• Professional in appearance and actions
• 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 maintain control of a call de-escalating issues and instilling confidence that a resolution will be found 
• Ability to function effectively under stress of conflicting demands on time and attention, while successfully meeting deadlines
• Enjoys learning new technologies and systems • Detail oriented, professional attitude, reliable
• Exhibits a positive attitude and is flexible in accepting work assignments and priorities
• Meets attendance and tardiness expectations, ability to work overtime, if required.
• 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 need
•  Able to communicate effectively in English, both verbally and in writing
• Ability for basic to intermediate problem solving, including mathematics
• Intermediate computer operation
• Proficiency with Microsoft Excel, Word, PowerPoint and Outlook
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Other Skills and Ability  

• Proficient computer skills, particularly in Microsoft 
• Good understanding of insurance payers and enrollment methods.  
• Ability to diagnose and resolve basic enrollment issues 
• Excellent organizational skills 
• Desire to gain industry knowledge and training 
• Demonstrates initiative in accomplishing goals 
• Ability to grow, adapt, and accept change 
• Consistently creating a positive work environment by being team-oriented 
• Excellent verbal, written, and social skills.  
• Ability to work overtime if/when needed

 

Location:

 Work takes place in a remote work environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and their driving record must meet company liability carrier standards.

 

Please do not contact the office directly – only resumes submitted through this website will be considered.

If you need assistance with this application, please contact (636) 227-2600

 

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. 

Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.