Provider Enrollment Specialist

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

📋 Description

• Prepare, submit, and monitor payer enrollment applications for new providers as well as modifications for existing providers.

• Ensure accurate documentation of enrollment activities within the credentialing system.

• Liaise with insurance companies, healthcare providers, and internal departments to facilitate efficient processing of applications.

• Track enrollment status and proactively follow up with payers to address any delays or complications.

• Update provider demographic and practice information with contracting payers.

• Adhere to recredentialing timelines and requirements to avoid lapses in enrollment.

• Work collaboratively with Field Support, Operations, and Revenue Cycle Management teams to address escalated enrollment or credentialing challenges.

• Investigate and resolve out-of-network claims issues by verifying provider participation status and effective enrollment dates.

• Coordinate temporary provider enrollments and complete necessary documentation, linkage, and payer updates.

• Partner with RCM on provider enrollment status and generate reports as required.

• Create and maintain status reports for enrollment activities.

• Assist with audits and perform additional tasks as assigned.

• Report directly to the Enrollment Manager.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• An Associate or Bachelor’s degree is preferred.

• 1–3 years of experience in payer enrollment is required.

• Familiarity with commercial payors and government payor requirements is essential.

• Proficient in Microsoft Office and credentialing software such as CAQH and Availity.

• Strong attention to detail, alongside excellent organizational and follow-up skills.

• Outstanding communication and customer service skills when interacting with both internal colleagues and external clients.

• Detail-oriented with robust analytical and problem-solving abilities.

• Experience with multi-specialty large group practices is preferred; experience in dentistry is an advantage.

• Knowledge of revenue cycle and billing processes is preferred.

• Familiarity with NPI and provider management files is preferred.

🏝️ Benefits

• Paid time off

• Health insurance

• Dental insurance

• Vision insurance

• 401(k) savings plan with matching contributions