Provider Enrollment Specialist

MDVIP: Transforming Primary Care, One Patient at a Time

MDVIP is a national leader in personalized healthcare, empowering over 425,000 members to achieve their health and wellness goals through a network of more than 1,400 concierge primary care physicians. Our program emphasizes preventive medicine, offering comprehensive screenings, advanced diagnostics, and individualized wellness plans. Recognized as a Great Place to Work® since 2018, MDVIP is committed to excellence in patient care and employee satisfaction. 

Thoroughly understands and manages the insurance credentialing/re-credentialing process and provides appropriate information and guidance. Coordinates and aids the Insurance Services Department in the resolution of complex or advanced issues and cases.  Compiles, runs, and completes various insurance related reports and presentations for Management. Liaison between insurance carriers, commercial and federal clearing houses, federal regulatory credentialing as well as, state, county, and federal licensing on behalf of affiliated MDVIP physicians for the purposes of insurance credentialing/re-credentialing.  

Key Performance Indicators

List measurable tasks that are key to indicating the performance level in this role:

1. Customer Satisfaction: Ensures physicians and/or stakeholders are satisfied with overall insurance credentialing process.
2. Outcomes: Sets appropriate expectations, deliveries, and alternatives to achieve optimal outcomes for the Insurance Credentialing program.
3. Compliance: Facilitates and ensures compliance with department and company policy and procedures while achieving established goals.

Essential Duties and Responsibilities / % of time

Credentialing Coordination:  60%

1. Coordinates all aspects of the credentialing process while delivering top quality customer service. Enters all pertinent data from applications into credentialing system and runs daily and weekly reports, etc.
2. Maintains credentialing system processes, and policy and procedures, ensuring adherence to all requirements and taking corrective steps as needed.
3. Represents doctors and companies interests while interfacing with insurance carriers, commercial and federal clearing houses, state/county/federal licensing, physicians and MDVIP staff as it relates to all aspects of MDVIP and the credentialing process, etc.
4. Identifies pertinent credentialing matters and provides analysis and resolution to Management weekly.

Metrics & Reporting: 25%

1. Establishes and communicates timelines with MDVIP affiliates or practices to ensure that schedules are met. Works directly with stakeholders to overcome any potential roadblocks.
2. Prepares, reviews, and sends status reports on an as needed basis to affiliated physicians and field staff. Follows-up to ensure closure on outstanding cases.
3. Creates and communicates physician credentialing status report(s) to internal Management in monthly meetings.

Escalation & Urgent Issues:  15%

1. In coordination with legal staff, assesses all credentialing related materials and reports and coordinates with outside professional staff to verify all outside processes are completed.
2. Provides analysis and recommendations to Management for escalated transition issues. Resolves escalated issues and assists on urgent requests.

Provides training and guidance to affiliates or respective billing companies related to MDVIP, when requested, on preventive billing protocols and/or credentialing needs.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Prolonged periods of sitting at a desk and using hands/fingers for working on a computer.
• Specific vision abilities include close vision and the ability to adjust focus from near to far.
• Must talk and/or hear for significant periods of each day.
• Must be able to lift and/or move up to 10 pounds periodically. 
• Limited travel for training or coordination of credentialing of an MDVIP affiliate may be required, not to exceed 10%.

Core Values and Competencies –

To perform the job successfully, an individual should demonstrate the following values and attributes:

IIPLT - Integrity – Innovation – Passion – Leadership – Trust

Effectively demonstrates organizational values consistently throughout their business interactions.

Analytical - Synthesizes complex or diverse information; Uses intuition and experience to complement data.

Collaboration – Openly collaborates and builds productive relationships with all; Values the perspective of people with different backgrounds and experiences.

Communication – Effectively listens, responds to the needs, views, and motivations of others. Writes clearly and concisely, using proper spelling and grammar; Speaks clearly and persuasively using good grammar and word selection.

Initiative – Identifies and creates solutions to meet needs of the role; Undertakes self-development activities; Seeks increased responsibilities.

Personal Accountability – Takes responsibility for own actions; Sets and meets reasonable deadlines; Reports timely and prepared for the day.

Problem Solving/Decision Making – Thinks strategically - drawing information from diverse and varied sources to identify issues, risks, and trends to determine optimal solutions allowing for informed and timely business decisions.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education / Experience / Knowledge:

Associate degree and at least two years related business experience; or equivalent combination of education and experience where two years related experience equals one year of schooling. Must have a strong understanding of the MDVIP model.

• Related and proven experience with a successful track record in a similar corporate role focused on coordination or management of credentialing/re-credentialing processes for primary physicians highly desired.
• Insurance experience and healthcare knowledge preferred.
• Must be able to develop thorough knowledge of CAQH, PECOS & NPPES applications.
• CRM, EMR, and/or credentialing software experience required. Net Docs, credentialing software, athena, Salesforce experience preferred.

Computer Proficiency:

Proficient in Microsoft Office applications.  Able to learn new software easily. 

Meets the following skill level requirements:

Microsoft Excel                             Basic             Intermediate                         Advanced

Microsoft Word                          Basic             Intermediate                         Advanced

Microsoft Outlook                       Basic             Intermediate                         Advanced

Microsoft PowerPoint                 Basic             Intermediate                         Advanced

CRM database                           Basic             Intermediate                         Advanced

Virtual: Zoom/Microsoft Teams   Basic             Intermediate                         Advanced

Document storage systems          Basic             Intermediate                         Advanced

Adobe                                        Basic             Intermediate                         Advanced

• Certified Provider Credentialing Specialist (CPCS) highly desired.

Why Join MDVIP?

• Be part of a mission-driven organization leading innovation in personalized healthcare.
• Drive transformation and growth in a dynamic, fast-paced environment.
• Competitive compensation: attractive base salary complemented by performance-based incentives for eligible roles.
• Comprehensive benefits: health, dental, vision insurance, and retirement plans.
• Professional development: access to ongoing training and leadership development programs.
• Positive work environment: consistently recognized as a Great Place to Work®, fostering a culture of collaboration and excellence. 

MDVIP is an Equal Opportunity Employer and is committed to fostering an inclusive and diverse workplace. We welcome applicants of all backgrounds and do not discriminate based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected status. We believe that diversity and inclusion drive innovation and strengthen our company culture.

If you require accommodation during the application or interview process, please let us know, and we will be happy to assist. 

Our compensation reflects the cost of labor across appropriate US geographic markets. Pay is based on several factors including but not limited to market location and may vary depending on job-related knowledge, skills, and education/training and a candidate's work experience. Hired applicants are offered annual incentive compensation programs, subject to applicable eligibility requirements. Payments under these annual programs are not guaranteed and are dependent upon a variety of factors including, but not limited to, individual performance, business unit performance, and/or the company's performance. The company offers the following benefits for this position, subject to applicable eligibility requirements. Medical/prescription drug coverage, Dental coverage, Vision coverage, Flexible Spending Account, Health Savings Account, Dependent Care Flexible Spending Account, Basic and Supplemental Life Insurance & Accidental Death and Dismemberment, Disability Income Protection Plan, Employee Assistance Program, 401(k) retirement program, Vacation, Paid Holidays and Personal time, Paid Sick and Family and Medical Leave time as required by law.