Provider Enrollment Specialist
About The Position
The Provider Enrollment Specialist manages the enrollment and revalidation of healthcare providers with government and commercial payers. The role ensures accurate, timely application submissions, maintains provider records, and supports compliance with payer, regulatory, and organizational requirements. The Specialist serves as a liaison among providers, payers, and internal departments to resolve enrollment issues, prevent claim delays, and support uninterrupted reimbursement. This is a full-time remote position requiring residence in Arizona, Texas, Tennessee, New Hampshire, Florida, or North Carolina. The role is based in the job listing as Work from Home – Richardson, TX, with a day shift and no travel. It has daily, ongoing contact with administrative staff, clinical providers, and outside contacts, and has no direct reports.
Requirements
- Excellent computer, data-entry, and clerical skills, including knowledge of business office procedures.
- Excellent interpersonal, telephone, and communication skills.
- Ability to multitask and handle varied situations with judgment and poise.
- Strong attention to detail and organizational abilities.
- Two or more years of payer credentialing experience.
- Two years of credentialing experience.
- A minimum of two to five years of experience and proven proficiency in provider enrollment payer credentialing.
- Associate’s degree in Business Administration or a related field, or an equivalent combination of education and experience.
Nice To Haves
- Working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and national standards.
Responsibilities
- Prepare, submit, and track provider enrollment, revalidation, and recredentialing applications with government and commercial payers.
- Maintain accurate provider demographic, licensure, certification, and contract information in enrollment systems, credentialing databases, and payer portals.
- Serve as the primary contact for providers regarding enrollment status, documentation requirements, timelines, and payer correspondence.
- Review applications for completeness, accuracy, and compliance before submission.
- Communicate with payer representatives to resolve discrepancies, follow up on pending submissions, and address denials or terminations.
- Coordinate with credentialing, billing, compliance, and contracting departments to align provider data and minimize claim rejections.
- Monitor enrollment statuses and proactively resolve issues that could delay provider activation or disrupt reimbursement.
- Document enrollment activities, correspondence, and approvals in accordance with organizational policies and audit standards.
- Ensure timely revalidation and recredentialing to prevent lapses in payer participation.
- Stay current on payer enrollment guidelines, CMS regulations, and industry best practices.
- Perform other duties as assigned.
Benefits
- Full-time positions are eligible for a discretionary bonus and a comprehensive benefits package.
- The company describes career advancement opportunities that support a healthy work/life balance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
