Provider Enrollment/ Billing Specialist

2 weeks ago

Southfield, United States CareerBuilder Full time

Job Description

Job Description

We are going at SEE Eyewear and our insurance billing team is seeking a Credentialing Specialist SEE Eyewear is addicted to uncovering hidden gems-and not just within our product assortment. We believe recruiting top talent and cultivating a unique, sophisticated and diverse group of experts from our associates and opticians to our Field Leaders. SEEs collection is an eclectic and unique assortment of the best of the best made exclusively for us. The same expectation stands for our people; we are committed to developing a Best in Class Team of Experts and Authorities where career development and growth are the foundation to building our brand.
The Credentialing Specialist is a critical role within the billing insurance team and will be responsible for all aspects of the credentialing, recredentialing and privileged processes for all optometrists and fill in optometrists at SEE Eyewear locations. Ensuring providers are credentialed, appointed, and privileged with health plans. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
This role will also assist the billing team with updating insurance plans and other duties as assigned for the billing department.
The Credentialing Specialist will work ONSITE, 5 days a week, 8:30am to 5pm at our HomeBase (headquarters) located in Southfield, Michigan, with the expectation of 1 Saturday a month. This job is not hybrid nor remote.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
Compiles and maintains current and accurate data for all providers.
Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
Maintains corporate provider contract files.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Sets up and maintains provider information in online credentialing databases and system.
Tracks license and certification expirations for all providers to ensure timely renewals.
Ensures practice addresses are current with health plans, agencies and other entities.
Tracks license, DEA and professional liability expirations for appointed ASC providers.
Maintains ASC appointment files, and information in credentialing database.
Audits health plan directories for current and accurate provider information.
ADDITIONAL RESPONSIBILITIES:
Maintains confidentiality of provider information.
Provides credentialing and privileging verifications.
Performs other duties as assigned.

QUALIFICATIONS:
Associate degree preferred
Certification/Licensure:

Certified Provider Credentialing Specialist (CPCS) preferred.
Experience: Two years of relevant credentialing experience
Ability to utilize computer-based POS system
Familiarity with Microsoft Office Suite

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