What are the responsibilities and job description for the Provider Enrollment Specialist position at Advance Community Health?
Company Overview
Advance Community Health is a Federally Qualified Healthcare Center in North Carolina serving Wake & Franklin Counties for 53 years delivering quality, compassionate primary health care - every patient, every time - in response to the needs of our communities. We are a model of affordable health care and a trusted partner, building healthy communities, one patient at a time.
Why Join Advance Community Health
Life in the Triangle, with the Atlantic Ocean only two hours to the east and the Blue Ridge Mountains 3.5 hours to the west, living and working in the Triangle area gives you the best life has to offer.
Advance Community Health (ACH) proudly offers employment opportunities in multiple locations throughout the Triangle, including Raleigh, Apex, Cary, and Fuquay-Varina! Our Raleigh office, conveniently located less than 6 minutes from the heart of Downtown Raleigh, gives you easy access to some of the best food and entertainment the Triangle has to offer! No matter who you are, the Triangle offers everything you need to live a happy, fulfilling life!
Position Summary
At Advance Community Health, our mission is to provide high-quality, accessible care to the communities we serve. Behind every provider delivering care is a seamless enrollment process that ensures patients receive the services they need without disruption.
We are seeking a detail-oriented and proactive Provider Enrollment Specialist to manage the full lifecycle of provider enrollment with Medicaid, Medicare, and commercial payers. This role is essential to ensuring our providers are credentialed, activated, and ready to serve patients without delays.
What You’ll Do
Provider Enrollment & Credentialing
- Manage end-to-end provider enrollment for:
- Medicaid (including NCTracks)
- Medicaid Managed Care plans & Medicare (PECOS)
- Commercial insurance payers
- Facility enrollments
- Complete initial enrollments, revalidations, updates, and terminations.
- Ensure accurate linkage of providers to NPIs, tax IDs, and service locations.
- Maintain and attest CAQH profiles in compliance with payer requirements.
- Track all applications from submission through approval and activation.
Payer Communication & Follow-Up
- Serve as the primary liaison with insurance payers
- Proactively follow up on applications to ensure timely approvals.
- Resolve denials, discrepancies, and enrollment issues.
- Escalate delays that may impact provider onboarding or billing.
Roster & Data Management
- Maintain accurate provider rosters and participation records.
- Ensure consistency across internal systems, CAQH, and payer directories.
- Process provider updates including additions, terminations, and demographic changes.
Compliance & Accuracy
- Ensure all enrollments meet federal, state, and payer requirements.
- Maintain audit-ready documentation.
- Safeguard sensitive provider information in compliance with HIPAA.
Collaboration & Support
- Partner with HR, operations, and billing teams to support provider onboarding.
- Communicate enrollment timelines, risks, and approvals to leadership.
- Help ensure providers are activated quickly and efficiently.
What You’ll Bring
Required Qualifications
- Associate degree 3 years of provider enrollment experience
- Hands-on experience with:
- Medicaid enrollment (NCTracks or similar systems)
- Medicaid Managed Care and Medicare (PECOS)
- Commercial payer enrollment processes
- Experience in multi-site or multi-specialty organizations preferred
Preferred Skills
- Strong understanding of insurance regulations and payer requirements
- Excellent written and verbal communication skills
- Strong problem-solving and organizational abilities
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency in Microsoft Office Suite
What Sets You Apart
- Detail-oriented with a commitment to accuracy
- Highly organized and able to meet deadlines
- Collaborative team player with a customer-focused mindset
- Driven to improve processes and deliver results
Apply Today
If you’re passionate about ensuring providers are set up for success and want to play a vital role in healthcare operations, we’d love to hear from you.
👉 Apply now and help us keep care moving forward.