ASC Provider Enrollment Lead - Eye Care Partners Career Opportunities

Enrollment Lead

Our growing eye care organization has an immediate need for an experienced Enrollment Lead who is familiar with provider data management and credentialing. 

GENERAL SUMMARY OF DUTIES: Works with and supports Managed Care, Revenue Cycle, Finance, Treasury and both internal and external customers in various regions to execute tasks related to new payer enrollments.

Represents the Provider Enrollment Dept and supports internal business partners in all aspects of initial credentialing and re-credentialing of ASCs with various Payor Plans, Government Agencies and State Agencies. Processes and monitors initial and renewal applications for ASCs/facilities. Communicates with ASCs, Contract Managers and Regional Directors regarding payer application processing, the collection of all required documentation; submission to payers and distributes approval documentation.

Maintains accurate, organized, and current files and databases; documents all work efforts in department's task workflow system; assists when needed in audits performed by regulatory and accrediting agencies, Department of Health, managed care organizations/payers, and others; and functions as managed care liaison, advisor and resource person for ASC administrators, business office staff, and other leadership personnel.

EDUCATION/EXPERIENCE:

1. 3-5 years of experience in managed care environment (with either payer or provider)

2. Bachelor's degree in healthcare and/or business preferred or equivalent in related experience

3. Experience in the completion of payer facility credentialing applications and an understanding of required facility credentials/licenses strongly preferred

ESSENTIAL FUNCTIONS: Payer Credentialing

· Process initial and re-credentialing ASC payer applications for Government (Medicare/ Medicaid), Commercial and Medicaid/Medicare replacement payers

· Correspond with ASC administrators, business office teams and contract team (Contract Managers and Regional Directors of Managed Care) regarding credentialing needs, status of provider files, or any other questions that arise. Notifies teams when actions are completed.

· Maintain system with accurate record keeping of payer application documents / approvals and ASC certifications, accreditations, licenses, etc.

· Sends organization ownership forms, renewed licenses and other applicable documents to payors as requested

· Manages payer credentialing audits and verification of payer participation statuses

· Performs quarterly payer data validation requests

· Performs payer notifications regarding facility demographics changes

· Other assigned duties as required

KNOWLEDGE:

1. Knowledge of Managed Care payers and products; Government and various state payers

2. Knowledge of the various payer portal platforms to complete enrollments –i.e. PECOS, Medicaid portal for various states, Availity, etc

3. Knowledge of CMS I&A, NPPES & the ability up update as necessary

4. Knowledge of Revenue Cycle operations as it applies to investigating & resolving denials when related to Provider Enrollment

5. Knowledge of credentialing software / platform

6. Knowledge of managed care insurance policies and procedures

7. Knowledge of state, federal and accreditation board regulations

SKILLS:

1. Microsoft Excel skills required

2. Analytical thinking and problem-solving skills

3. Skilled in outbound calls for follow-up and problem resolution- phone soft skills a must

4. Skilled in gathering and reporting credentialing/certification information.

5. Skilled in written and verbal communication and customer relations

6. Skilled in working with Windows based software systems

7. Skilled in the use of PDF editor applications – i.e., Adobe Pro

8. Skilled in Intermediate Microsoft Word Proficiency in Microsoft Office such as Word, Outlook, and PowerPoint

ABILITIES:

1. Attention to detail and organization a must

2. Ability to communicate professionally and effectively a must and work effectively with internal and external customers

3. Ability to maintain strict confidentiality with demonstrated experience applying good judgment and discretion

4. Ability to identify, analyze and solve credentialing problems

5. Ability to handle multiple tasks/projects and reach varied deadlines

6. Ability to serve as a resource person, resolve administrative problems, and exercise sound judgment in decision-making

7. Excellent time management skills

8. Exceptional ability to plan, organize, and implement a plan to completion.

9. Ability to prioritize duties and be self-motivated

10. Ability to navigate credentialing software platform

Physical Requirements

While performing the duties of this job, the employee is regularly required to talk and hear. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must frequently lift and/or move up to 10 pounds.

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

If you need assistance with this application, please contact (636) 227-2600

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Please do not contact the office directly – only resumes submitted through this website will be considered.