Provider Enrollment Specialist ( OH, MI, KS) - LOOKING FOR MI INSURANCE KNOWLEDGE/EXPERIENCE

Job Title: Provider Enrollment Specialist

We are looking to target candidates in these states: Kansas, Michigan, Ohio,

LOOKING FOR MI INSURANCE KNOWLEDGE/EXPERIENCE

Job Summary

The Provider Enrollment Specialist is responsible for managing high-volume, end-to-end provider enrollments for a growing ophthalmology organization. This role owns the full lifecycle of payer enrollment—from application preparation and submission through approval and activation— ensuring providers are enrolled accurately and efficiently.

The position also supports provider onboarding by initiating and completing hospital privileging applications and maintaining regular communication with operational leaders. This role is primarily focused on enrollment and payer coordination, with limited involvement in credentialing. The Specialist works closely with providers, internal teams, Medical Staff offices and insurance payers to minimize delays and support timely revenue cycle activation.

Duties and Responsibilities

• Serve as the primary point of contact for provider enrollment-related inquiries from internal teams and providers.

• Manage full-cycle (end-to-end) provider enrollments, including application preparation, submission, follow-up, approval, and payer activation.

• Prepare and submit initial enrollment applications with Medicare, Medicaid, and commercial payers.

• Proactively track and follow up on all pending enrollments to ensure timely approvals and reduce delays in provider participation.

• Maintain accurate and up-to-date provider enrollment data across all systems and tracking tools.

• Monitor enrollment statuses and provide regular updates to leadership and key stakeholders.

• Maintain strong working relationships with insurance payer representatives to expedite issue resolution.

• Update and maintain provider information in CAQH, NPPES, and payer portals as it relates to enrollment accuracy.

• Process provider demographic updates, including practice locations, group affiliations, and specialty changes

• Initiate, complete, and submit provider hospital privileging and re-privileging applications, ensuring all required documentation is accurate and timely.

• Coordinate with hospitals and medical staff offices to track privileging application status and approvals.

• Lead and participate in biweekly calls with practice leaders, providing enrollment status updates, addressing issues, and aligning on onboarding timelines.

• Maintain internal enrollment and privileging records, ensuring accurate data and audit ready.

• Support limited credentialing functions, such as basic data verification or re-credentialing paperwork, as needed.

• Ensure compliance with Medicare, Medicaid, and Managed Care payer regulations and requirements.

• Coordinate payer-related aspects of provider onboarding to support timely go-live dates

• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.

• Performs other duties that may be necessary or in the best interest of the organization.

Education:

High School Diploma or GED Required

Preferred: Associate’s Degree (Healthcare Administration, Business, or related field)

Experience Requirements

• 2+ years of provider enrollment experience in a healthcare setting, preferably within a multi-site or specialty practice (ophthalmology experience preferred).

• Demonstrated experience managing end-to-end provider enrollments with Medicare, Medicaid, and commercial payers.

• Experience initiating and completing hospital privileging applications and coordinating with medical staff offices

Knowledge, Skills and Abilities Requirements

• Strong working knowledge to manage payer enrollment processes, timelines, and regulatory requirements

• Base understanding of the credentialing processes

• Able to manage high-volume workloads and multiple priorities with minimal supervision.

• Professional in appearance and actions

• Logical and Critical thinking skills for problem solving and analysis.

• Proficiency in resolving enrollment delays and denials efficiently.

• In-depth knowledge of performance metrics

• Ability to function effectively under stress of conflicting demands on time and attention, while successfully meeting deadlines

• High attention to detail, professional attitude, reliable

* Maintaining high level of accuracy in data entry and documentation.

• Exhibits a positive attitude and is flexible in accepting work assignments and priorities

• Meets attendance and tardiness expectations, ability to work overtime, if required.

• Management and organizational skills to support the leadership of this function

• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations

• Ability to work collaboratively across departments while maintaining individual interpersonal skills to support customer service, functional, and teammate support need

* Able to communicate effectively in English, both verbally and in writing

* Ability to work collaboratively across departments.

• Ability to learn new technologies and systems to track and report on enrollment status’ using spreadsheets, databases, or enrollment software

• Intermediate computer operation

* Proficiency with Microsoft Excel, Word, PowerPoint and Outlook

• Specialty knowledge of systems relating to job function

• CAQH, NPPES, PECOS, and Payer-specific enrollment portals

* Preferred: Data management system (Availity)

• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Location:

Work takes place in a remote work environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and their driving record must meet company liability carrier standards.

Please do not contact the office directly – only resumes submitted through this website will be considered.

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.

Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.