Provider Enrollment Specialist

ACLD•Bethpage, NY

1d•$25 - $30•Hybrid

About The Position

CEC Healthcare, a not-for-profit Federally Qualified Health Center (FQHC), is dedicated to providing high-quality, compassionate, and accessible healthcare services to the communities we serve. Our mission-driven team supports patients across multiple locations while promoting health equity and improving community wellness. We are seeking a detail-oriented and organized Provider Enrollment Specialist to join our team. This position plays a critical role in ensuring that healthcare providers are properly credentialed, enrolled, and maintained within Medicare, Medicaid, and commercial payer systems to support uninterrupted patient care and reimbursement processes. Based on the needs of the organization, occasional travel between our Bethpage, Glen Cove, and Seaford locations is required. The Provider Enrollment Specialist supports provider credentialing, enrollment, affiliation, and provider data management processes. This role ensures compliance with federal and state regulations, payer requirements, and FQHC standards while supporting provider onboarding, credentialing maintenance, and reimbursement readiness.

Requirements

High School Diploma or equivalent.
Strong organizational skills and attention to detail.
Proficiency with Microsoft Office Suite, including Excel, Word, and Outlook.
Excellent written and verbal communication skills.

Nice To Haves

Associate degree.
At least one year of experience in provider enrollment, credentialing, medical staff services, healthcare administration, or a related field.
Experience with Medicare and Medicaid enrollment processes, particularly New York State Medicaid/eMedNY.
Familiarity with CAQH, PECOS, NPPES, and healthcare credentialing platforms.
Knowledge of CMS, HRSA, and FQHC operational guidelines.

Responsibilities

Assist with initial credentialing, recredentialing, enrollment, and revalidation applications for Medicare, Medicaid (including NY eMedNY), and commercial insurance plans.
Maintain accurate provider information within credentialing systems such as CAQH, PECOS, and NPPES.
Track application status and proactively follow up with payers to ensure timely approvals.
Verify and maintain provider licensure, board certifications, DEA registrations, malpractice coverage, education credentials, and other required documentation.
Ensure timely provider revalidations in accordance with CMS and New York State Department of Health requirements.
Maintain credentialing files in compliance with HRSA, FQHC, and audit standards.
Collaborate with Human Resources, Compliance, and Clinical Leadership on provider onboarding and termination processes.
Monitor provider enrollment status to minimize disruptions in billing and reimbursement.
Support payer roster updates and enrollment changes.
Stay informed of Medicare, Medicaid, and commercial payer regulatory updates.
Respond to credentialing and enrollment inquiries from internal and external stakeholders.
Maintain compliance with HIPAA privacy and security standards.
Assist with departmental reporting, audits, and special projects as needed.