Sr. Provider Enrollment Specialist

XIFIN • Westlake Village, CA

100d • $22 - $29

About The Position

The Sr. Specialist, Provider Enrollment is responsible for managing and executing provider enrollment activities specific to Radiology Group practices, ensuring timely approvals and accurate maintenance to meet Medicare, Medicaid, and commercial payer requirements. This role ensures adherence to federal, state, and payer-specific requirements, supporting the initial enrollment process and ongoing participation of providers and Radiology Group practices in government and commercial health plans. The Sr. Specialist will serve as a subject matter expert in Radiology enrollment, working closely with physicians, practice administrators, billing teams, and regulatory entities to ensure accurate, timely submissions and approvals. This position will sit in our office in either Charleston, SC or Westlake Village, CA.

Requirements

• Bachelor’s degree in healthcare administration, business, or related field preferred.
• Minimum 5 years of provider enrollment experience, with at least 3 years in Medicare and Medi-Cal enrollment.
• Radiology and Teleradiology-specific enrollment experience highly preferred.
• Strong understanding of enrollment systems such as CMS PECOS, NPPES, CAQH, Medi-Cal, Availity, etc.
• Deep familiarity with Medicare Part B and Medi-Cal fee-for-service and managed care enrollment rules.
• Exceptional organizational skills with the ability to manage multiple providers and deadlines.
• Strong written and verbal communication skills to clearly and professionally communicate with internal teams, providers and payer representatives.
• Proficiency with Microsoft Office Suite and enrollment tracking systems.

Nice To Haves

• Detail-oriented with a high level of accuracy.
• Ability to interpret complex enrollment policies and payer guidelines and apply them to daily workflows.
• Problem-solving and escalation management skills.
• Strong customer service mindset when interacting with providers and stakeholders.
• Capacity to work independently and as part of a collaborative team.
• Ability to safeguard sensitive provider and organizational information in compliance with HIPAA regulations, ensuring confidentiality, security, and ethical management of sensitive information.

Responsibilities

• Prepare, submit, and track Medicare, Medicaid, and commercial payer enrollment applications for Radiologists and Radiology Group practices.
• Maintain current knowledge of enrollment requirements across multiple payers, with a strong emphasis on CMS (Centers for Medicare & Medicaid Services) and DHCS (California Department of Health Care Services) guidelines.
• Manage the full lifecycle of provider enrollment updates including revalidations, re-enrollments, portal re-attestations, and changes of information (COI) for Radiologists and Radiology Group practices.
• Audit enrollment records for accurate submissions, timely application processing, payer follow-up, and regulatory requirements to ensure all applications and supporting documents meet payer-specific guidelines.
• Develop and maintain provider enrollment policies, checklists, and best practices specific to Radiology.
• Serve as the primary point of contact for Radiologists, practice managers, and payer representatives.
• Provide status updates on applications and resolve escalated enrollment issues.
• Collaborate with credentialing, revenue cycle, and compliance teams to align processes.
• Update and maintain provider enrollment databases with accurate and current provider information, ensuring thorough documentation of all communications and enrollment activities.
• Generate reports on enrollment status, expirations, and pending applications.
• Track enrollment timelines to minimize delays in reimbursement.
• Assist with audits and special projects.

Benefits

• Comprehensive health benefits including medical, dental, vision, and telehealth.
• 401(k) with company match and personalized financial coaching to support your financial future.
• Health Savings Account (HSA) with company contributions.
• Wellness incentives that reward your preventative healthcare activities.
• Tuition assistance to support your education and growth.
• Flexible time off and company-paid holidays.
• Social and fun events to build community at our locations!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees