Managed Care Specialist

Description & Requirements

Position Description & Requirements

PRACTICE OVERVIEW

Bloom Family Eye Surgeons through its owned and affiliated practices is a leading provider of comprehensive medical and surgical eye clinic in Indiana and Ohio. As a physician-led and physician-owned, we offer complete medical eye examinations by specialists in the field of ophthalmology, including the diagnosis, management and treatment of eye diseases featuring in-house surgery in our state-of-the-art Surgery Center. Our Optometric Eye Clinic offers the diagnosis, management and treatment of a wide range of eye diseases, including a wide range of eyewear.

POSITION SUMMARY

The Payor Enrollment and Credentialing Specialist will report to the Revenue Cycle Manager and focus on: initiating credentialing and provider enrollment application, coordinates information collections, verification, and documentation, enters data in NextGen and provider portals ensuring all required documentation is received timely for the payer credentialing process.

POSITION DUTIES AND RESPONSIBILITIES

· Works directly with the Revenue Cycle Manager to coordinates and provide administrative support for payer credentialing, enrollment and payer contracting.

· Initiates credentialing and provider enrollment activities in a timely, comprehensive, and well-organized manner, per Bloom Family Eye Surgeons established policies and procedures.

· Enters data in the physician profiling system per established policies and procedures

· Coordinates and facilitates all fee schedules by gathering the required documentation to enter in NextGen based on the payer contractual agreements.

· Closely monitors information collection, makes cognitive analysis of all information received, appropriately evaluating the quality of the documentation received, pursuing additional information, if necessary, for effective, comprehensive, and successful provider enrollment.

· Performs timely follow up for all outstanding provider enrollment applications and contracts.

· Prepares all necessary reports to include all required information for submission to other departments related to provider enrollment and contracts.

· Understand Provider Enrollment requirements to ensure regulatory compliance, including but not limited to Council for Affordable Quality Healthcare (CAQH), National Plan and Provider Enumeration System (NPPES), Provider Enrollment Chain and Ownership System (PECOS), Joint Commition Accreditation of Healthcare Organization (JCAHO) and National Committee for Quality Assurance (NCQA) standards, through ongoing review.

· Maintains documentation of all provider enrollment records with required supporting information for periodic provider re-enrollment, re-certification, and regulatory surveys.

· Ensure that all provider enrollment files are maintained in an appropriate manner on an ongoing basis.

· Performs root cause analysis for any errors found and takes required action steps to resolve all denials relating to inaccuracies for rendering physicians.

DESIRED TECHNICAL AND PROFESSIONAL SKILLS AND EXPERIENCE

· Bachelor's Degree in Business, Finance, Health Administration or other related area.

· Minimum of 10 years of experience in managed care, enrollment, and credentialing.

· Strong leadership and management skills with the ability to effectively manage multiple locations in Ohio.

· Knowledge of commercial and government healthcare billing regulations.

· Minimum of 2 years of experience in NextGen EHR billing system.

· Excellent verbal and written communication skills and attention to details.

· Ability to work independently with minimal supervision.

· Advanced use of Microsoft Office applications (Word, Excel, PowerPoint, Outlook) and vendor resources relating to vendor portals.

Job Type: Full-time

Benefits:

• Flexible schedule
• Health insurance
• Vision insurance

Work Location: In person