Provider Enrollment and Network Mgmt Specialist

Easterseals PORT Health•Raleigh, NC

22h•$50,000 - $60,000•Remote

About The Position

The Provider Enrollment and Network Management Specialist coordinates organizational payer enrollments, site and service additions, network participation, directory maintenance, and payer implementation activities. The specialist is the primary liaison between Easterseals PORT Health and Commercial, Medicare, Medicaid, and Managed Care Organization (MCO) payers to support timely implementation and maintenance of organizational sites and services. This is a full-time, non-exempt, overtime-eligible position paying $50,000 to $60,000. It is mostly remote in North Carolina, with intermittent travel to offices in the state. The employee must reside within commuting distance of an office location. The role works with Operations, Credentialing, Revenue Cycle Management, Quality Management, and program leadership. It supports EHR improvement initiatives and payer incentive programs, maintains enrollment records and tracking resources, and provides activity reports and status updates to leadership. Other duties may be assigned, including driving as required.

Requirements

Associate's degree in Healthcare Administration, Business Administration, or a related field, or an equivalent combination of education and experience.
Three years of experience in provider enrollment, managed care operations, credentialing support, healthcare administration, or related functions.
Knowledge of payer enrollment and network participation processes.
Strong organizational, project management, and problem-solving skills.
Ability to manage multiple priorities and deadlines.
Strong attention to detail and follow-through.
Excellent verbal and written communication skills.
Ability to work collaboratively across departments.
Proficiency in Microsoft Office Suite, including Excel, Outlook, Word, SharePoint, and Teams.
Ability to maintain confidential and sensitive information.
Ability to develop written communication and review work for accuracy.
Ability to communicate effectively with internal and external clients and remain in a stationary position for extended periods.
Must reside within a commutable distance of an Easterseals PORT Health office in North Carolina.

Nice To Haves

Experience working with Medicare, Medicaid, Commercial, and Managed Care Organization payers.
Experience in Behavioral Health, Intellectual and Developmental Disabilities (I/DD), and Substance Use Disorder (SUD) services.

Responsibilities

Coordinate and manage organizational site and service enrollments with Commercial, Medicare, Medicaid, and Managed Care Organization payers.
Prepare, submit, and track applications and supporting documentation for new site, service, and program implementations.
Monitor enrollment status and follow up with payer representatives to support timely processing and implementation.
Coordinate site relocations, closures, service modifications, and organizational demographic changes with payers.
Coordinate site and service participation with applicable payers during implementation of newly executed payer contracts, and communicate updates to internal stakeholders.
Serve as the primary administrative contact for payer communications related to site and service participation.
Maintain payer directory accuracy and coordinate resolution of directory discrepancies.
Collaborate with Operations, Credentialing, Revenue Cycle Management, Quality Management, and program leadership on enrollment and implementation activities.
Support Electronic Health Record (EHR) improvement initiatives and payer incentive programs.
Maintain enrollment tracking logs, databases, and supporting documentation.
Prepare reports and provide regular enrollment and implementation status updates to leadership.
Ensure enrollment records and related documentation are accurate and complete.
Perform other duties as assigned, including driving as required for the position.