Enrollment Specialist
About The Position
The Enrollment Specialist is responsible for coordinating, monitoring, and maintaining provider enrollment activities with commercial health plans, government payers, and other applicable healthcare organizations. This role serves as a key resource for provider enrollment by tracking applications, conducting payer follow-up, resolving enrollment discrepancies, and ensuring provider information is accurately maintained across payer systems. In addition, the Enrollment Specialist supports provider credentialing updates, demographic maintenance, roster management, and Health Information Credentialing Excellence (HICE) audits. The position works collaboratively with Credentialing, Contracting, Billing, Operations, and other internal stakeholders to support timely provider enrollment and ongoing payer participation.
Requirements
- High school diploma or equivalent required.
- Proficiency with Microsoft Office applications, including Excel, Word, and Outlook.
Nice To Haves
- Associate's degree or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
- Two (2) or more years of experience in provider enrollment, credentialing, healthcare administration, medical group operations, payer operations, or a related healthcare environment preferred.
- Experience working with commercial and/or government health plans preferred.
- Experience using payer portals and provider databases preferred.
Responsibilities
- Coordinate and monitor initial and ongoing provider enrollment applications with commercial health plans, Medicare, Medi-Cal, and other applicable payers.
- Track enrollment applications from submission through completion and maintain accurate status documentation.
- Conduct routine follow-up with health plans and payer representatives regarding pending applications, missing information, processing delays, and enrollment determinations.
- Identify enrollment issues and discrepancies and collaborate with internal departments and payer representatives to resolve them.
- Monitor requests for additional documentation and ensure required information is obtained and submitted in a timely manner.
- Maintain comprehensive enrollment tracking systems, databases, spreadsheets, and payer records.
- Escalate delayed, denied, or otherwise problematic enrollments to leadership as appropriate.
- Assist with provider demographic and practice location updates across payer systems.
- Support provider credentialing and recredentialing activities.
- Maintain and update provider affiliations, specialties, addresses, tax identification information, NPI information, and other payer-required data.
- Ensure accurate provider information is maintained within CAQH, PECOS, NPPES, payer portals, and other applicable systems.
- Review provider information for accuracy and identify discrepancies between internal records and payer databases.
- Assist with provider roster reconciliation and coordinate correction of identified discrepancies.
- Support credentialing and enrollment-related projects as assigned.
- Assist with HICE audits and other internal or external compliance reviews.
- Gather, organize, validate, and maintain provider enrollment and credentialing documentation for audit requests.
- Review provider files to identify missing, incomplete, or inconsistent information.
- Track audit-related action items and support timely completion of documentation requests.
- Maintain organized records to support audit readiness and regulatory compliance.
- Escalate compliance concerns or documentation deficiencies to leadership as appropriate.
- Maintain accurate, complete, and confidential provider enrollment records.
- Ensure enrollment activities and payer communications are thoroughly documented.
- Prepare and maintain enrollment reports and status updates.
- Identify recurring payer issues, enrollment trends, and process improvement opportunities.
- Adhere to organizational policies, payer requirements, and applicable regulatory and compliance standards.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
