Provider Enrollment Coordinator

HealthPartners•Bloomington, MN

About The Position

HealthPartners is hiring a Provider Enrollment Coordinator to manage provider enrollment and revalidation with federal, state, and commercial payers, ensuring timely and accurate participation status. The role supports the onboarding lifecycle for physicians, advanced practice clinicians, and other healthcare providers by coordinating documentation, monitoring applications, and communicating status updates to internal stakeholders and external agencies. It helps ensure compliance with organizational standards and payer-specific requirements while preventing revenue disruption and supporting operational efficiency. The position handles enrollment across 10 entities and several outside contract entities. It prepares and tracks initial enrollment applications and revalidations, maintains provider and payer data, monitors approval timelines, and supports provider onboarding. It also maintains accurate enrollment records and supports compliance reviews, audits, and process improvement.

Requirements

High school diploma or equivalent.
At least 2 years of experience in provider enrollment, medical staff services, credentialing, or revenue cycle operations.
Strong knowledge of Medicare and Medicaid enrollment processes and commercial payer requirements.
Excellent organizational skills and attention to detail.
Ability to manage multiple deadlines and shift priorities.
Strong communication skills and comfort interacting with providers and payer representatives.

Nice To Haves

Associate or bachelor's degree in business, healthcare administration, or a related field.
Experience with CAQH, PECOS, NPPES, and common credentialing or enrollment software systems.

Responsibilities

Prepare, submit, and track initial enrollment applications for Minnesota and Wisconsin Medicare, Minnesota and Wisconsin Medicaid, and contractual plans, using the required profiles, forms, spreadsheets, and portals.
Prepare and submit revalidations for Minnesota and Wisconsin Medicare, Minnesota and Wisconsin Medicaid, and commercial insurance plans.
Reassign providers with Medicare Part A for Critical Access Hospitals.
Maintain provider enrollment information, including name changes, terminations, and practice-location changes.
Monitor approval timelines and proactively resolve enrollment delays or discrepancies.
Update CAQH, PECOS, NPPES, and contractual payer databases.
Re-attest provider data every 120 days to ensure accuracy for contractual plans.
Enroll providers with out-of-state Medicaid programs according to state-specific requirements.
Add assigned plan codes in EPIC after receiving confirmation that a provider is enrolled.
Collaborate with recruitment teams, credentialing, and Clinic Operations to align start dates and enrollment readiness.
Assist providers with payer-required documentation and signatures.
Serve as an enrollment subject matter expert for leadership, recruiters, and clinic teams.
Provide providers with a positive, professional onboarding experience.
Ensure enrollment processes follow federal and state regulations, payer guidelines, and organizational policies.
Maintain accurate digital records of applications, correspondence, approvals, and effective dates.
Support audits, quality reviews, and process improvement initiatives.