Enrollment Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee and manage initial and ongoing enrollment applications for providers with commercial health plans, Medicare, Medi-Cal, and other relevant payers.

• Monitor the progress of enrollment applications from submission to completion, ensuring accurate documentation of their status.

• Follow up with health plans and payer representatives regarding applications that are pending, missing information, experiencing processing delays, or awaiting enrollment decisions.

• Identify any enrollment-related issues and discrepancies, collaborating with both internal teams and payer representatives to find resolutions.

• Keep track of requests for additional documentation and guarantee that necessary information is collected and submitted promptly.

• Maintain comprehensive enrollment tracking systems, databases, spreadsheets, and records associated with payers.

• Bring to the attention of leadership any enrollments that are delayed, denied, or problematic.

• Assist in updating provider demographic and practice location information across payer systems.

• Support activities related to provider credentialing and recredentialing.

• Ensure the accuracy of provider affiliations, specialties, addresses, tax identification numbers, NPI details, and other data required by payers.

• Verify that provider information is correct in CAQH, PECOS, NPPES, payer portals, and additional systems.

• Review provider data to identify discrepancies between internal records and payer databases.

• Assist in reconciling provider rosters and coordinating necessary corrections.

• Contribute to projects related to credentialing and enrollment.

• Aid in HICE audits and other compliance assessments.

• Collect, organize, validate, and maintain enrollment and credentialing documentation for audit purposes.

• Examine provider files for any missing, incomplete, or inconsistent information.

• Track action items from audits and assist in fulfilling documentation requests.

• Keep records organized for audit readiness and compliance with regulations.

• Ensure provider enrollment records are accurate, complete, and kept confidential.

• Document all enrollment activities and communications with payers.

• Generate enrollment reports and updates on status.

• Identify recurring issues with payers, trends in enrollment, and opportunities for process improvements.

• Comply with organizational policies, payer requirements, and regulatory standards.

• Collaborate with Credentialing, Contracting, Billing, Operations, and other stakeholders.

⛳️ Requirements

• High school diploma or equivalent is required.

• An Associate's degree or Bachelor's degree in Healthcare Administration, Business Administration, or a related field is preferred.

• A minimum of two (2) years of experience in provider enrollment, credentialing, healthcare administration, medical group operations, payer operations, or a similar healthcare setting is preferred.

• Experience with commercial and/or government health plans is preferred.

• Familiarity with using payer portals and provider databases is preferred.

• Proficiency in Microsoft Office applications, including Excel, Word, and Outlook.

• Understanding of provider enrollment and payer participation processes.

• Knowledge of commercial and government payer requirements.

• Familiarity with CAQH, PECOS, NPPES, payer portals, and provider roster management.

• Knowledge of provider credentialing and recredentialing procedures.

• Awareness of healthcare compliance requirements and audit documentation practices.

• Understanding of HICE audit standards and procedures.

• Familiarity with maintaining provider demographic, affiliation, TIN, and NPI information.

• Ability to safeguard confidential provider, patient, organizational, and business information.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on work-life balance.

• Access to healthcare resources and wellness programs.