Medicare & Medicaid Enrollment Analyst

Curana Health, Inc.•Remote,

3d•Remote

About The Position

The Medicare & Medicaid Enrollment Analyst is responsible for overseeing and managing all Medicare and Medicaid enrollment revalidations for both individual providers and provider groups. This role serves as the organization's subject matter expert on government payer enrollment processes, ensuring timely revalidation, maintenance, and compliance with federal and state regulations. The coordinator manages the full revalidations for physicians, nurse practitioners, physician assistants, and organizational entities to ensure uninterrupted billing, reimbursement, and regulatory compliance. The position works collaboratively with Credentialing, Revenue Cycle, Compliance, Billing, and Operations teams to support organizational growth and provider onboarding initiatives.

Requirements

High School Diploma or equivalent required.
Minimum of three years of Medicare and Medicaid experience.
Experience managing both provider and organizational/group enrollments.
Strong knowledge of CMS enrollment regulations, PECOS, Medicare revalidation requirements, and state Medicaid enrollment processes.
Experience working with enrollment tracking systems and provider management platforms.
Strong organizational, analytical, and problem-solving skills.

Nice To Haves

Multi-state Medicare and Medicaid experience.
Experience with CredentialStream, CAQH, and provider enrollment software platforms.
Experience supporting physician groups, skilled nursing facility practices, long-term care organizations, or multi-state healthcare organizations.

Responsibilities

Prepare, submit, and monitor individual and group Medicare revalidations through PECOS.
Manage Medicare revalidations and enrollment maintenance requests.
Track PTAN assignments, effective dates, and approval statuses.
Coordinate electronic signatures and supporting documentation required for Medicare revalidations.
Maintain compliance with CMS regulations and Medicare Administrative Contractor (MAC) requirements.
Submit revalidation Medicaid applications for both individual providers and provider organizations.
Coordinate state-specific Medicaid enrollment requirements and supporting documentation.
Monitor application status and resolve deficiencies with state Medicaid agencies.
Develop and maintain tracking systems for all Medicare and Medicaid revalidation activities.
Monitor revalidation due dates, enrollment expirations, and regulatory deadlines.
Conduct routine follow-up with Medicare contractors and state Medicaid agencies.
Ensure all enrollment milestones are documented and reported accurately.
Escalate delayed or high-risk applications to leadership as appropriate.
Ensure all activities comply with CMS, Medicare, Medicaid, and organizational requirements.
Maintain complete and audit-ready enrollment files and supporting documentation.
Assist with internal audits, accreditation reviews, and regulatory requests.
Monitor changes in Medicare and Medicaid enrollment policies and communicate impacts to stakeholders.
Implement process improvements to enhance enrollment efficiency and accuracy.
Serve as the primary resource for Medicare and Medicaid revalidation guidance.
Collaborate with Billing, Revenue Cycle, Credentialing, Compliance, and Operations teams.
Research and resolve enrollment-related billing delays, claim denials, and reimbursement issues.
Provide status updates and reporting to leadership and operational stakeholders.