Provider Enrollment Specialist

• Prepare and submit provider enrollment applications for Medicare, Medicaid, and commercial payers across all applicable locations. Monitor application status, follow up as needed, and provide weekly updates on all pending submissions. Maintain accurate records of provider identifiers, effective dates, and participation status.
• Monitor and manage the re-credentialing and revalidation processes to ensure ongoing compliance with payer requirements
• Maintain a current list of NPI/PTAN/Promise and other insurance related ID numbers
• Serve as the point of contact between payors and the company regarding credentialing status, requests for information, and issue resolution.
• Investigate and resolve enrollment-related issues, including denials and delays, through independent research and follow-up.
• Maintain accurate and up-to-date credentialing files, a master list of all enrolled payors with renewal/revalidation dates. Maintain all needed documentation (licenses, bank info, provider details, ownership info etc.) for successful enrollment
• Manage EDI/EFT/ERA enrollment efforts with payors and Clearinghouse.
• Ensure timely and accurate completion of enrollment applications. Ensure timely updates to payor portals and internal systems (e.g., CAQH, PECOS, Availity).
• Support audits and payer communications related to credentialing and enrollment status.
• Timely update enrollment data in internal tracking systems and external payer portals to ensure accuracy and compliance.
• Proactively monitor revalidation timelines and initiate renewals to prevent reimbursement disruptions.
• Support the maintenance of accurate provider rosters within enrollment system(s).
• Generate and distribute regular enrollment status reports to leadership and operational stakeholders.
• Contribute to the design and implementation of improved enrollment workflows aimed at increasing efficiency, reducing processing time, and improved reporting to stakeholders.
• Assist in the creation and maintenance of standard operating procedures (SOP) to guide consistent and timely enrollment and revalidation processes.
• Collaborate with cross-functional teams—including Credentialing, Billing, Human Resources, Clinical Leadership, and providers—to support seamless onboarding and reimbursement across all service locations.
• Actively pursue professional development to enhance job-related knowledge and skills.
• Independently seek out and utilize appropriate information and resources to complete tasks effectively.
• Perform additional duties as assigned by management.

Required Minimum Qualifications:

• High school diploma required
• Minimum 2 years of experience in payer enrollment, credentialing, or medical billing, ideally in an FQHC or similar fast-paced environment.

Added-Value Qualifications and Experience:

• Bachelor’s degree in business, Healthcare Administration, or a related field (or equivalent experience) preferred.
• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) is preferred.

Required Skills/Abilities:

• Ability to use and understand computer applications
• Working knowledge of medical terminology, insurances and billing
• Must be detailed oriented and capable of working independently with minimal supervision
• Familiar with insurance portals: (PECOS, CAQH, Promise, Availity, Navinet, UHC)
• Strong understanding of Medicaid/Medicare enrollment, CAQH, and state-specific payer regulations.
• High level of attention to detail, proficiency in Microsoft Office (Excel), and strong verbal/written communication skills.