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Provider Enrollment Specialist - Phoenix (22nd Street & Camelback)

Credentialing

  • Posted: 04 June 2020
  • Full-time
  • Phoenix, AZ, USA

At American Vision Partners (AVP), we’re bringing the best together. Our company was created with the affiliation of Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, and the M&M Eye Institute. Today we’re one of the nation’s largest and most comprehensive ophthalmology practices with more than 45 eye care centers in Arizona and New Mexico - including 24 ambulatory surgical centers. At AVP we are committed to best in class patient care, being a pioneer in research and technology and most importantly, rewarding and recognizing our employees!

As a Provider Enrollment Specialist, you'll be responsible for assisting with the administration of the provider enrollment process for assigned new and existing providers. You'll also be responsible for assisting in obtaining and maintaining information essential to complete the credentialing/re-credentialing process.

Responsibilities:

  • Prepares and submits the initial re-credentialing enrollments to all applicable health plans for individual providers as well as facilities.
  • Uses current versions of forms are used for the provider enrollment function.
  • Utilizes the credentialing database adequately enough with the goal of making fastest submissions to health plans and within the established timeline.
  • Makes timely follow-up of submitted enrollments with the goal of getting providers and/or facilities enrolled in a timely manner.
  • Interacts with representatives from health plans to answer inquiries and clarify requirements.
  • Assists with identifying issues that require additional investigation and evaluation, validates discrepancies and reports them to immediate supervisor.
  • Assists in maintaining an accurate provider CAQH databases and uploads documents in a timely manner.
  • Performs re-attestations on CAQH every 3 months as required by the CAQH and Health plans.
  • Performs provider demographic updates every 3 months as required by Medicare and Health plans.
  • Generates and replies to correspondence related to provider enrollment in a timely manner.
  • Makes adequate follow-up notes on provider smart sheets records.
  • Files correspondence in provider files in a timely manner.
  • Audits health plan directories for current and accurate provider information.
  • Maintains an accurate credentialing database.
  • Maintains accurate document filing in appropriate provider and facility folders.
  • Performs miscellaneous job related duties as assigned.

Qualifications:

  • High School Diploma or equivalent
  • Credentialing Data Base experience required. ECHO preferred. 
  • Provider Enrollment Specialist Certificate (PESC) or Certified Provider Credentialing Specialist (CPCS) or similar certification in credentialing, health plan or network management highly preferred.
  • Minimum 1 year of experience in Provider Enrollment and Credentialing fields is required for this position

  • Must have working knowledge in Managed Care and/or Network Management

  • Proficiency in MS applications including and not limited to credentialing database software
  • Strong organizational skills and ability to pay attention to detail
  • Excellent communication skills and problem solving abilities within a team environment
  • Ability to work independently and prioritize assigned duties within given time frames
  • Ability to establish and maintain effective working relationships with insurance representatives, providers and coworkers

Benefits & Perks:

 Your health, happiness and your future matters! At AVP, we offer everything from medical and dental to significant eye care discounts, continuing education, 401(k), 9 paid holidays plus PTO, flexible work hours and much more!

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. 

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