Provider Enrollment Specialist

Advance Community Health•Raleigh, NC

17h

About The Position

At Advance Community Health, our mission is to provide high-quality, accessible care to the communities we serve. Behind every provider delivering care is a seamless enrollment process that ensures patients receive the services they need without disruption. We are seeking a detail-oriented and proactive Provider Enrollment Specialist to manage the full lifecycle of provider enrollment with Medicaid, Medicare, and commercial payers. This role is essential to ensuring our providers are credentialed, activated, and ready to serve patients without delays.

Requirements

Associate degree + 3+ years of provider enrollment experience
Hands-on experience with: Medicaid enrollment (NCTracks or similar systems) Medicaid Managed Care and Medicare (PECOS) Commercial payer enrollment processes
Experience in multi-site or multi-specialty organizations preferred

Nice To Haves

Strong understanding of insurance regulations and payer requirements
Excellent written and verbal communication skills
Strong problem-solving and organizational abilities
Ability to manage multiple priorities in a fast-paced environment
Proficiency in Microsoft Office Suite
Detail-oriented with a commitment to accuracy
Highly organized and able to meet deadlines
Collaborative team player with a customer-focused mindset
Driven to improve processes and deliver results

Responsibilities

Manage end-to-end provider enrollment for: Medicaid (including NCTracks) Medicaid Managed Care plans & Medicare (PECOS) Commercial insurance payers Facility enrollments
Complete initial enrollments, revalidations, updates, and terminations.
Ensure accurate linkage of providers to NPIs, tax IDs, and service locations.
Maintain and attest CAQH profiles in compliance with payer requirements.
Track all applications from submission through approval and activation.
Serve as the primary liaison with insurance payers
Proactively follow up on applications to ensure timely approvals.
Resolve denials, discrepancies, and enrollment issues.
Escalate delays that may impact provider onboarding or billing.
Maintain accurate provider rosters and participation records.
Ensure consistency across internal systems, CAQH, and payer directories.
Process provider updates including additions, terminations, and demographic changes.
Ensure all enrollments meet federal, state, and payer requirements.
Maintain audit-ready documentation.
Safeguard sensitive provider information in compliance with HIPAA.
Partner with HR, operations, and billing teams to support provider onboarding.
Communicate enrollment timelines, risks, and approvals to leadership.
Help ensure providers are activated quickly and efficiently.