Provider Enrollment Specialist

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

📋 Description

• Prepare, submit, and monitor payer enrollment applications for both new providers and changes to existing providers.

• Keep precise records of enrollment activities within the credentialing system.

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

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

• Update provider demographic and practice information with contracting payers.

• Maintain timelines and requirements for recredentialing to avoid enrollment lapses.

• Collaborate 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 examining provider participation status and enrollment effective dates.

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

• Work with RCM on provider enrollment status and provide reports as required.

• Create and maintain reports on enrollment status.

• Assist with audits and carry out other assigned responsibilities.

• Report directly to the Enrollment Manager.

⛳️ Requirements

• High school diploma or equivalent is a must.

• An Associate or Bachelor’s degree is preferred.

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

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

• Proficiency in Microsoft Office and credentialing software, including CAQH and Availity.

• Strong attention to detail, organizational skills, and ability to follow up are crucial.

• Excellent communication and customer service skills for interactions with internal teams and external clients.

• Strong analytical and problem-solving abilities are necessary.

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

• Knowledge of revenue cycle and billing processes is advantageous.

• Familiarity with NPI and file provider management is preferred.

🏝️ Benefits

• Paid time off

• Health insurance

• Dental insurance

• Vision insurance

• 401(k) savings plan with match