Job Details

Melville, NY - USA

Position Requirements

The Provider Enrollment Specialist II will be responsible for the larger and/or overarching functions of the provider enrollment credentialing process they manage within team territories they are assigned such as larger payors, special tasks, Government payors or Provider Liaison services.

Responsibilities:

For Provider Enrollment Specialist II with larger payors, team tasks or Government payor responsibilities

• Complete and accurately submit provider enrollment applications, spreadsheets, and letters
• Research & keep current on payer, hospital, ASC & office-based guidelines as needed to ensure processes are accurate.
• Review and create workflows to identify accuracy, efficiency, and best practices.
• Assist provider enrollment credentialing staff in their zone/region, monitor workflows, and provide support and training as required
• Follow up with payors to ensure timely enrollment, re-enrollment, and participation
• Review and follow up on weekly billing reports
• Data entry of all provider information into the Credentialing Database
• Handle incoming requests from physicians, payors, and other agencies
• Verify integrity of data
• Oversee the completion of online provider CAQH re-attestations
• Assist with the development and maintenance of departmental policies and procedures
• Assist/lead new business implementations
• Assist in internal departments by resolving payment and denial issues as it relates to credentialing
• Travel between hospitals and other clinical work locations to meet with providers to obtain signatures on required documents as needed
• Facilitate and attend meetings and seminars as required
• Produce weekly and monthly productivity and issues report for management
• Other responsibilities as assigned

For Provider Enrollment Specialist II that manage Provider Services liaison responsibilities for the team

• Be able to initiate and act as liaison between providers and all Specialists within their territory/group with professionalism, respect and within time frames to maximize efficiencies
• Assist credentialing staff in their zone/region, monitor workflows, and provide support and training as required
• As region/zone Provider Services point person, assist, and interact with Regional Clinical and Operational leadership by assisting with resolving any provider enrollment issues, questions or concerns and/ or expedite processes for enrollment processes
• Travel between hospitals and other clinical work locations to meet with providers to obtain signatures on required documents as needed
• Facilitate and attend meetings and seminars as required
• Produce weekly and monthly productivity and issues report for management
• Other responsibilities as assigned

Qualification/Requirement:

• Positive and professional attitude
• Ability to work with all levels of associates from entry level to upper-level management
• Ability to work independently or in a group setting
• Previous credentialing or enrollment experience a plus
• Strong knowledge of provider enrollment credentialing in a physician office, managed care or hospital setting
• Must be a self-starter and a team player who enjoys providing the highest level of customer service.
• Experience working with databases, and ability to create and manipulate excel spreadsheets
• Ability to multi-task and prioritize in a fast-paced environment
• Strong communication and follow up skills
• Professional business sense and leadership skills
• Strong experience with Microsoft Office (Excel & Word specifically)
• Local & distance travel may be required.

Education and/or Experience

• Associates Degree, Bachelors Degree, and/or equivalent work experience. A minimum of three years provider enrollment/credentialing experience.

Total Rewards

• Salary: $19.39-$26.66 hourly
• Generous benefits package, including:
• Paid Time Off
• Health, life, vision, dental, disability, and AD&D insurance
• Flexible Spending Accounts/Health Savings Accounts
• 401(k)
• Leadership and professional development opportunities

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.