Provider Enrollment Specialist

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

📋 Description

• Oversee the entire process of provider and facility payer enrollment applications, ensuring precision and timely submissions from start to finish.

• Gather, assess, and validate documentation necessary for provider and facility enrollments.

• Complete applications for payer enrollment, hospital credentialing, professional licensure, and other related processes in line with payer requirements and government regulations.

• Ensure the accuracy of information across credentialing and enrollment databases and payer portals, including Availity, CAQH, NaviNet, NPPES, and PECOS.

• Track pending applications, identify shortcomings, and resolve issues to maintain the progression of enrollments.

• Investigate and address provider and facility enrollment challenges in collaboration with internal teams and external payer representatives.

• Monitor revalidations, license renewals, and other necessary updates to guarantee compliance and enrollment status.

• Assist the Credentialing Manager with onboarding new facilities, locations, and providers as the organization expands into new markets.

• Appropriately escalate complex or unresolved credentialing and enrollment challenges.

• Deliver prompt, professional support to internal stakeholders throughout the enrollment journey.

• Collaborate with various teams within the organization, payers, and regulatory systems.

⛳️ Requirements

• High school diploma or its equivalent.

• A minimum of 3 years of experience in healthcare, specifically in payer relations, market access, managed care, provider enrollment, credentialing, or a related area.

• Excellent organizational abilities and a keen eye for detail.

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

• Capability to juggle multiple priorities, meet deadlines, and uphold accuracy in a highly detail-oriented setting.

• Strong communication skills and a customer service-oriented mindset.

• Proven accountability, professionalism, and integrity.

• Experience with MedTrainer Credentialing software is preferred.

• Familiarity with managed care contracts and payer requirements is preferred.

🏝️ Benefits

• Competitive hourly wage.

• Paid holidays plus 2 Floating Holidays.

• Approximately 10 days of Paid Time Off (PTO) within the first year.

• Comprehensive benefits package including medical, dental, and vision coverage.

• 401(k) retirement plan.