Provider Enrollment Specialist
Position Summary
The Provider Enrollment Specialist is responsible for managing all aspects of provider enrollment with Medicaid, Medicare, and commercial payers. This role ensures timely submission, accurate documentation, and continuous follow‑up to secure approvals, effective dates, and network participation. The ideal candidate is organized, proactive, and experienced in navigating payer systems and enrollment workflows.
Key Responsibilities
- Prepare, submit, and track provider enrollment applications for Medicaid, Medicare, and commercial insurance plans.
- Maintain accurate provider data, including CAQH profiles, NPPES updates, and payer‑specific documentation.
- Monitor application status, follow up with payers, and resolve issues to prevent delays.
- Ensure compliance with federal, state, and payer‑specific requirements.
- Communicate professionally with payers, providers, and internal teams.
- Assist with revalidations, recredentialing cycles, demographic updates, and group/location linkages.
- Maintain detailed records of enrollment activities and timelines.
- Support credentialing and revenue cycle teams as needed to ensure seamless onboarding and billing readiness.
- Identify and escalate enrollment barriers or delays that may impact revenue.
- Protect all provider and organizational information by adhering to confidentiality standards.
Qualifications
Education
- High School Diploma or equivalent required
- Additional training in healthcare administration, billing, or credentialing preferred
Experience
- Minimum 2 years of provider enrollment or credentialing experience required, FQHC experience preferred but not required.
- Experience with Medicaid, Medicare, and commercial payer enrollment processes.
- Familiarity with CAQH, PECOS, NPPES, and payer portals.
Skills & Competencies
- Strong attention to detail and accuracy
- Excellent communication and customer‑service skills
- Ability to manage multiple deadlines and prioritize effectively
- Strong problem‑solving and follow‑up abilities
- Proficiency with EHR/practice management systems and payer portals
- Ability to work independently in a remote or hybrid environment
- Commitment to confidentiality and compliance
Work Environment & Benefits
- Fully remote and hybrid positions available.
- Flexible schedules, report directly to the Credentialing Manager.
- Competitive benefits package.
- Supportive, mission‑driven team culture.
- Opportunities for growth within a rapidly expanding company.