Analyst, Provider Enrollment

MDVIP•Boca Raton, FL

About The Position

MDVIP is seeking a Provider Enrollment Analyst reporting to the Manager of Insurance Programs. The role manages the insurance provider enrollment process for MDVIP physician affiliates and requires an understanding of credentialing and contracting procedures, along with the ability to provide accurate guidance and support to affiliated physicians, physician staff, and internal teams. The Analyst coordinates with and supports the Insurance Services Department in resolving complex or advanced issues and serves as a liaison between MDVIP and insurance carriers, commercial and federal clearinghouses, and state, county, and federal regulatory bodies. The role ensures compliance with licensing and credentialing requirements for affiliated physicians and manages provider enrollment and contracting workflows, including non-standard cases, data integrity, reporting, training, and escalations.

Requirements

Associate’s degree and at least two years of related business experience.
Four years of related work experience.
Familiarity with EMR and credentialing software.
Proficiency in Microsoft Office applications.
Successful track record in a similar corporate role focused on coordination or management of provider enrollment.
Ability to interpret complex data using experience and critical thinking.
Ability to build collaborative, productive relationships with physicians, physician staff, and stakeholders.
Clear, professional, and effective communication across diverse audiences.
Ability to identify solutions proactively, pursue growth, and seek added responsibility.
Accountability, ability to meet deadlines, and preparedness for daily work.
Strategic thinking to assess risks, trends, and opportunities for informed decision-making.

Nice To Haves

Experience with CAQH, PECOS, and NPPES applications.
Experience with Net Docs, credentialing software, and athena.
Certified Provider Credentialing Specialist (CPCS).
Certified Provider Enrollment Specialist (CPES).
Experience with Salesforce or other CRM tools.

Responsibilities

Manage non-standard provider enrollment workflows and interpret payer-specific contract requirements, including complex cases outside templated processes.
Coordinate provider enrollment and contracting from start to completion, provide responsive service, educate physicians about timelines, and manage expectations and operational challenges.
Serve as the primary liaison and subject-matter expert for provider enrollment, collaborating with physicians, internal stakeholders, and external partners.
Complete statewide credentialing applications to establish new groups and add providers to commercial payers and Medicare.
Analyze and reconcile provider enrollment data across systems, identify discrepancies and downstream risks, and assess potential effects on revenue, access, or compliance.
Maintain provider enrollment system processes, policies, and procedures; ensure adherence to requirements and take corrective steps as needed.
Use independent judgment to resolve enrollment obstacles and exceptions, escalating high-risk, systemic, or time-sensitive issues with solution options and impact assessments.
Manage, validate, and reconcile complex provider records across high-volume, payer-specific enrollment workflows.
Provide requested training and guidance to affiliates, physician staff, or billing companies on MDVIP preventive billing protocols and provider enrollment needs.
Develop, analyze, and distribute timely status reports to affiliated physicians and field staff, and follow up to resolve and close outstanding cases.
Compile, validate, and deliver insurance-related reports and management presentations, translating complex data into clear insights for decision-making and operational planning.
Analyze complex enrollment and contracting issues, provide root-cause analysis and actionable recommendations to management, and resolve escalated issues and urgent requests.
Ensure provider enrollment data supports accurate contracting, payer submissions, and ongoing network compliance.

Benefits

Medical and prescription drug coverage
Dental coverage
Vision coverage
Flexible Spending Account
Health Savings Account
Dependent Care Flexible Spending Account
Basic and Supplemental Life Insurance and Accidental Death and Dismemberment coverage
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
Annual incentive compensation programs for eligible roles, subject to eligibility requirements and performance factors
Ongoing training and leadership development programs