Provider Enrollment Coordinator

Presbyterian Healthcare Services

6d•$17 - $25•Onsite

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Provider Enrollment Coordinator. Processes payer enrollment applications for all PHS‑employed or contracted healthcare providers. Supports the Provider Enrollment Manager in directing the system‑wide enrollment process to ensure all responsible providers are billable. Prepares, submits, and tracks enrollment applications with contracted health plans, maintaining communication with providers throughout the process. Generates applications, gathers required documents, secures signatures, and submits completed packets to payers. Obtains and distributes PINs/enrollment numbers to billing offices. Maintains strong working relationships with Medical Staff Affairs, Credentialing, Business Office, Contracting, PMG, regional administrators, and external agencies to support timely enrollment and maximize revenue.

Requirements

Associates Degree preferred or at least three years of experience in a medical, business or medical staff affairs office required.
Possess strong interpersonal skills and able to relate positively to health care providers.
Possess basic computer skills including use of Windows, MS Office and Outlook.
High school diploma

Nice To Haves

Claims processing and medical terminology experience a plus

Responsibilities

Provides consultative support to PMG providers and sites on enrollment processes, licensing, and payer requirements, maintaining current knowledge of regulatory standards.
Assists the department manager with delegated payer audits and maintains provider enrollment files in compliance with NCQA and confidentiality requirements.
Reviews practitioner applications and credentials to generate accurate enrollment packets.
Collaborates with Provider Navigators, Medical Staff Affairs, Presbyterian Health Plan, CVO staff, contracting, and billing teams to identify new providers, determine required health plan enrollments, and communicate PINs and taxonomy updates.
Processes all provider changes (e.g., pointage, specialty, function, terminations) and completes required payer applications.
Performs audits using Cactus reports, risk management term reports, payer reports, and internal file reviews.
Manages monthly updates and uploads of the Provider Directory, credentialing grid, and new‑provider status reports.
Assists in training new staff and contributes to developing and revising departmental policies, procedures, criteria, audit tools, and desktop manuals.
Conducts denial management for assigned providers, reviewing write‑off and denial reports, escalating issues as needed, and following up on outstanding claims.
Handles purging and preparation of termed provider files for scanning.
Investigates and resolves customer complaints from EWC related to assigned providers.
Serves as departmental representative and point of contact for contracted payer meetings.