Provider Enrollment Specialist

Midwest Vision Partners - Brecksville, OH

Full-time - Mid Level

Brecksville, OH

1,001-5,000 employees

Ambulatory Health Care Services

About the position

The Provider Enrollment Specialist is responsible for ensuring that healthcare providers are enrolled and re-enrolled with commercial and government payers in a timely and compliant manner. This role involves completing applications, gathering necessary documentation, and maintaining accurate credentialing files, while also serving as a liaison between various departments to ensure compliance with regulations.

Responsibilities

• Complete all applications in accordance with government and payor standards and submit applications within the required reporting period.
• Gather and obtain all appropriate documentation for facilities and physicians' payor enrollment.
• Perform necessary follow-up with each Contractor and respond to all inquiries or requests within the allotted timeframe.
• Communicate effectively with the facility Managers, Payors, and Physicians.
• Research facility or physician enrollment and credentialing related issues.
• Work with the staff to adhere to new policies and communicate necessary changes as impacted by regulations.
• Oversee credentialing process by notifying Credentialing Verification Organization (CVO) and Payors of new and terminated providers and of any changes.
• Complete Payor facility credentialing applications.
• Maintain accurate credentialing files for physicians, physician assistants and all allied health professionals.
• Review and enter physician logs into database.
• Serve as liaison between Credentialing Department and all other facilities to assist with education of and compliance with Medical Staff Bylaws.
• Assist in performing internal compliance investigations and audits throughout the organization.

Requirements

• At least three years credentialing/compliance experience in a healthcare setting.
• Knowledge of credentialing policies and procedures.
• Knowledge of government application filing.
• Knowledge of record-keeping practices.
• Knowledge of customer service principles and techniques.
• Skill in using word processing, spreadsheet and database management.
• Skill in communicating clearly and concisely.
• Skill in handling confidential information.
• Ability to analyze, extract and interpret government enrollment and billing regulations.
• Skill in understanding of practice compliance regulations.

Benefits

• 401(k) matching
• Dental insurance
• Health insurance
• Paid holidays
• Paid time off