Lead Provider Enrollment Specialist

Rural Physicians Group•Greenwood Village, CO

10d•Remote

About The Position

Rural Physicians Group is seeking a full-time Lead Provider Enrollment Specialist to oversee and coordinate the daily operations of the provider enrollment team. This role ensures timely, accurate, and compliant enrollment of physicians and physician groups with Medicare, Medicaid, and Commercial payers. The Lead Provider Enrollment Specialist acts as the subject-matter expert, supports team members, maintains quality standards, and collaborates with internal stakeholders for seamless enrollment workflows.

Requirements

Strong knowledge of Medicare, Medicaid, and Commercial payer enrollment processes.
Ability to lead and support a team in a fast-paced, frequently changing environment.
Excellent attention to detail, decision-making, and problem-solving abilities.
Exceptional organizational skills with the ability to prioritize and coordinate multiple tasks.
Strong written and verbal communication skills, including the ability to de-escalate difficult conversations.
Ability to work independently while also collaborating effectively with other departments.
Experience maintaining confidentiality and adhering to HIPAA guidelines.
Proficiency with provider enrollment systems, patient accounting systems, and general computer applications.
Minimum 3–5 years of Provider Enrollment experience in a healthcare setting, including demonstrated leadership or mentorship responsibilities.

Nice To Haves

Associate degree, industry certification(s), or Bachelor's degree in Business, Accounting, Finance, Healthcare Administration, or related field.
Prior experience in a lead, senior, or supervisory role within enrollment or credentialing.

Responsibilities

Provide day-to-day guidance, support, and direction to Provider Enrollment Specialists.
Assign and monitor workload, ensuring tasks are completed accurately and within required timelines.
Serve as the primary escalation point for enrollment issues, payer challenges, or delays.
Train new staff members and assist in developing training materials, SOPs, and best practices.
Maintain high-level awareness of payer requirements, regulatory changes, and enrollment standards; communicate updates to the team.
Mentor, coach, and onboard team members to elevate overall team capability and performance.
Serve as a subject matter expert and go-to resource for complex or escalated issues.
Anticipate challenges and propose proactive solutions.
Ensure all providers are fully and accurately enrolled with Medicare, Medicaid, and Commercial payers in alignment with organizational timelines.
Review and approve enrollment applications prior to submission to guarantee accuracy and completeness.
Oversee the maintenance of detailed provider files, ensuring licenses, SSNs, tax IDs, and credentialing documentation are up to date.
Monitor CAQH profiles for all providers and ensure timely attestation and updates.
Manage tracking systems to prevent lapses in enrollment and reduce claim denials related to provider setup.
Partner with internal departments to ensure smooth onboarding and changes to provider status.
Respond to escalated correspondence or inquiries from providers and payers regarding enrollment status or issues.
Support leadership with reporting, metrics, and operational updates related to enrollment activities.
Ensure all workflows meet departmental, state, and federal regulatory requirements.
Maintain strict confidentiality of provider and patient information in compliance with HIPAA.
Identify areas for process improvement and recommend solutions to streamline enrollment operations and enhance accuracy.
Assist with special projects or additional duties as needed.
Serve as a senior resource to the Provider Enrollment team by supporting training, mentoring new staff, and providing expert guidance on payer-specific requirements.
Assist leadership in refining workflows, improving processes, and implementing operational efficiencies.
Collaborate closely with internal departments—including Billing, Compliance, HR, and Operations—to resolve complicated enrollment issues and ensure seamless onboarding.
Support leadership with departmental reporting, process audits, and special projects as assigned.