Provider Enrollment Specialist Tier III
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Job Location:
Monthly Salary:
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Company Intro
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
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
- Associates 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!
Required Experience:
IC
Key Skills
About Company
Our partner practices, including Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, and Aiello Eye Institute have on average been in practice for more than 35 years.
