Provider Enrollment Specialist Jobs

About The Position

Requirements

• Bachelor's degree in Health Administration, Business, or a related field, or equivalent experience.
• At least 2 years of experience in provider enrollment, credentialing, or payer relations within a hospital or health system.
• Strong knowledge of Medicare, Medicaid, and commercial payer enrollment requirements.
• Excellent organizational skills and ability to manage multiple applications simultaneously.
• Proficiency with enrollment software platforms such as CAQH and PECOS, and Microsoft Office Suite.
• Effective communication skills for interacting with providers, payers, and internal teams.
• Detail-oriented approach with a focus on regulatory compliance and accuracy.
• Ability to analyze enrollment data and produce actionable reports.

Nice To Haves

• Experience working in a multi-regional or multi-site health organization.
• Certified Provider Enrollment Specialist (CPE) or similar credential.

Responsibilities

• Submit and track enrollment applications for physicians, APPs, and eligible practitioners with Medicare, Medicaid, and commercial payers.
• Maintain current credentialing files, including licenses, certifications, and privileging documents.
• Coordinate with medical staff services to verify provider privileges and resolve discrepancies.
• Monitor enrollment status dashboards and proactively address pending or denied applications.
• Communicate enrollment requirements and updates to providers and practice leadership.
• Collaborate with revenue cycle teams to ensure accurate payer linkage for billing.
• Respond to payer inquiries, audits, and re-credentialing requests in a timely manner.
• Develop and maintain standard operating procedures and documentation for enrollment processes.
• Train and support new providers on enrollment workflows and compliance expectations.
• Generate regular reports on enrollment metrics, turnaround times, and compliance status for senior management.