Provider Enrollment Specialist

This is a fully remote position, open to applicants in Arizona, +5 more states.

📋 Description

• Oversee the enrollment and revalidation processes of healthcare providers with both government and commercial payers.

• Prepare, submit, and monitor applications for provider enrollment, revalidation, and recredentialing.

• Keep accurate records of provider demographics, licenses, certifications, and contractual agreements.

• Act as the main point of contact for providers concerning their enrollment status, required documentation, timelines, and communications with payers.

• Assess applications for completeness, accuracy, and compliance with relevant standards.

• Liaise with payer representatives to address discrepancies, follow up on submissions, and handle denials or terminations.

• Collaborate with credentialing, billing, compliance, and contracting teams.

• Track enrollment statuses and resolve any issues that may hinder activation or affect reimbursement.

• Record enrollment activities, correspondence, and approvals meticulously.

• Ensure timely revalidation and recredentialing of providers.

• Keep up-to-date with payer enrollment guidelines, CMS regulations, and industry best practices.

• Maintain regular communication with administrative staff, clinical providers, and external contacts.

• No direct reports; perform additional duties as assigned.

⛳️ Requirements

• Must reside in Arizona, Texas, Tennessee, New Hampshire, Florida, or North Carolina.

• High School diploma is required.

• An Associate’s degree in Business Administration or a related field is preferred, or an equivalent combination of education and experience.

• A minimum of two years of experience in payer credentialing is required.

• At least two years of experience in credentialing is necessary.

• Proven proficiency in provider enrollment payer credentialing with a minimum of two to five years of relevant experience.

• Strong computer, data entry, and clerical skills are essential.

• Familiarity with business office procedures is expected.

• Excellent interpersonal, clerical, telephone, and communication skills are required.

• Ability to multitask effectively and manage varied situations requiring sound judgment and composure.

• Strong attention to detail and organizational skills are a must.

• A demonstrated understanding of the healthcare and credentialing industries, including knowledge of medical-legal issues, laws, regulatory agencies, and national standards is preferred.

🏝️ Benefits

• Full-time positions are eligible for a discretionary bonus.

• Comprehensive benefits package offered.

• Opportunities for career advancement are available.

• Promotion of a healthy work/life balance.

• Support and encouragement to reach your full potential.