Provider Enrollment Specialist II

2 months ago

Melville, United States North American Partners In Anesthesia Full time

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.

Essential duties and 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, Bachelor's Degree, and/or equivalent work experience. A minimum of three years provider enrollment/credentialing experience.
Total Rewards
  • Salary: $22.00 - $30.00
  • 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.

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