Provider Enrollment Specialist II

Altais

2d•$21 - $25

About The Position

At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Provider Enrollment Specialist II supports Family Care Specialists (FCS), Altais Medical Group Riverside (AMGR), and Altais Medical Group Bay Area (AMGBA) by independently managing the full lifecycle of provider credentialing, recredentialing, and payer enrollment. This role ensures compliance with AMG policies, health plan delegation requirements, NCQA standards, and government payer rules while maintaining accurate and up‑to-date provider information across systems, portals, and payer platforms. The Provider Enrollment Specialist II handles moderately complex enrollment issues, works collaboratively across departments, and supports efficient onboarding to avoid revenue disruption.

Requirements

High school diploma or equivalent
3–5 years of healthcare credentialing and payer enrollment experience; IPA, physician group, or Revenue Cycle experience preferred.
Excellent computer skills, including Microsoft Office (Word, Outlook, Excel, PowerPoint).
Ability to use independent judgment and initiative within established policies and procedures.
Strong relationship‑building skills across all levels of staff, management, and external payer contacts.
Excellent written and verbal communication skills.
Exceptional organizational skills and the ability to manage multiple projects concurrently.
Ability to obtain, synthesize, and analyze data and recommend solutions.
Ability to draft presentations, handouts, and communications.
Demonstrates a learning and growth mindset; proactive and solution‑oriented.

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) preferred.
National Association Medical Staff Services (NAMSS) coursework or certification preferred.

Responsibilities

Manage and coordinate all aspects of payer enrollment for new and existing providers, including tracking progress, deadlines, and payer requirements.
Verify group‑level versus provider‑level contracts to confirm enrollment steps required by each payer.
Complete and submit payer enrollment applications (including signature‑required forms) and perform proactive follow‑up to expedite approvals.
Utilize payer portals to submit information, track status, manage rosters, and complete provider demographic updates, location changes, and revalidations.
Utilize Athena practice management to identify enrollment issues, and complete tasks related to provider configuration.
Communicate provider changes to contracted health plans and FCS, AMGR, and AMGBA management via standardized reports.
Manage Medicare revalidation cycles and submit updates through PECOS.
Perform annual Medi‑Cal renewals and maintain records in PAVE.
Work within the EHR/practice management system (Athena) to identify, troubleshoot, and resolve enrollment‑related issues.
Collaborate with IT/EHR analysts, Revenue Cycle, and Operations to correct provider setup, payer participation mapping, NPI/taxonomy assignments, and other configuration components required for clean claim submission.
Independently troubleshoot complex EHR enrollment errors to prevent billing delays.
Responsible for all aspects of credentialing/recredentialing providers, including verification of applications and documents, mailing of requests for consideration, preparing initial applications, issuing approval/denial/termination letters, and accurately loading provider information in credentialing databases.
Process credentialing and recredentialing applications accurately and promptly in accordance with FCS, AMGR, and AMGBA policies, health plan delegation requirements, and NCQA standards.
Perform credentialing for health plans, hospital medical staff, and surgery centers.
Track and maintain renewal‑based provider credentials, including licenses, DEA registrations, board certifications, malpractice coverage, and other compliance documents.
Disseminate new or modified professional information to FCS, AMGR, and AMGBA providers and departments.
Coordinate credentialing and recredentialing task grids and tickler systems to ensure follow‑up and timely completion.
Responsible for accurate input, updates, and modifications to the credentialing database; perform routine audits to assure accuracy.
Review state and federal sanctions bulletins and update provider files accordingly.
Prepare materials for external audits by payors and governmental agencies; ensure files remain audit‑ready.
Maintain up‑to-date records across internal databases, CAQH, PECOS, PAVE, payer portals, and contract files.
Coordinate responses to payer inquiries; follow up with payers and providers to completion.
Maintain effective communication with health plan representatives and AMG departments.
Participate in training sessions related to payer enrollment and credentialing workflows; collaborate with team members to meet weekly enrollment goals.