Melville,NY - USA

Position Requirements

RESPONSIBILITIES

• Essential duties and responsibilities outlined for a Provider Enrollment Specialist II
• Understand regulations and requirements of all payors for all zones and regions to ensure requirements and criteria are met for enrollment
• Ensure CAQH, Facility, Payer, Implementation, Client Services & other regulatory requirements for provider enrollment credentialing are adhered to
• Cover workload for open positions, vacations etc.
• Provide subject matter expertise to assist Pod Captains in staff trainings
• Identify trends of obstacles and problem situations for resolution
• Ensure billing platform is updated timely for release of claims
• Assist internal departments by resolving payment and denial issues as it relates to credentialing

REQUIRED QUALIFICATIONS

• Strong communication and follow-up skills
• Strong organizational and time management skills
• Aptitude for escalating appropriate issues and problems early in the process
• Ability to work independently and as a team
• Ability to multitask and prioritize tasks
• Strong knowledge of provider credentialing in a physician office, managed care, and hospital setting
• Positive and professional attitude
• Detail oriented with strong problem-solving skills
• Independent Problem solving
• Advanced knowledge with Athena, Microsoft Excel, Word, and Zoom
• Local & distance travel may be required
• Functional expertise using applicable internal programs including, but not limited to, Athena, Credential Stream, Workday
   

PREFERRED QUALIFICATIONS

• Associates degree, bachelor’s degree preferred, or equivalent experience accepted
• Minimum of 3-5 years of provider enrollment/credentialing

Total Rewards

• Salary: $23.79- $32.00
• 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

Provider Enrollment Specialist III will be responsible and accountable for specialized provider enrollment, as well as operational tasks for Provider Enrollment across all Zones/Regions. This includes but is not limited to processing of specialized provider enrollment processes and workflows, including Implementation of new business, data integrity, provider pending holds and special projects. Other responsibilities include assisting with oversight of all provider enrollment related activities associated with all zones/regions as well as operational functions for the team, coaching, mentoring and special projects.

Specialist III will have the skills and knowledge in problem solving, credentialing software, billing platform, reporting, data integrity, and data analysis.

Proficiency in credentialing, CMS, DOH, PECOS, Medicare, Medicaid, and commercial payors is a must. Microsoft proficiency including Word, Excel, and Power Point is required.

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.