[Hiring] Provider Enrollment Specialist @Blue Cloud

Role Description

The Provider Enrollment Specialist is responsible for managing provider and entity enrollments, recredentialing, and payer enrollment activities with Medicare, Medicaid, and commercial insurance plans. This role ensures timely and accurate enrollments, maintains provider records, resolves payer-related issues, and supports uninterrupted billing and reimbursement operations. The ideal candidate is highly organized, detail-oriented, proactive, and capable of independently managing a high-volume workload across multiple states.

• Facilitate initial enrollments, recredentialing, and payer enrollment applications for providers and entities with Medicare, Medicaid, and commercial insurance plans.
• Prepare, review, and submit enrollment applications, ensuring accuracy, completeness, and timely submission.
• Monitor enrollment application status and conduct proactive follow-up with payers to resolve issues and expedite approvals.
• Establish and maintain strong relationships with payer representatives.
• Document all payer communications and enrollment updates within the credentialing system.
• Maintain accurate provider and entity records, credentialing information, and enrollment data.
• Track enrollment, credentialing, and recredentialing deadlines to prevent interruptions in participation or reimbursement.
• Complete and submit EFT agreements and related payer documentation.
• Maintain and update provider information in payer directories and databases.
• Manage and maintain provider CAQH profiles, ensuring all information remains current and accurate.
• Collaborate with Revenue Cycle, Billing, Credentialing, Operations, and other internal stakeholders to address enrollment-related issues and questions.
• Provide enrollment status updates, reporting, and turnaround-time metrics to leadership.
• Independently prioritize workload and successfully manage multiple enrollments simultaneously.
• Research, troubleshoot, and resolve enrollment barriers with minimal supervision.
• Manage multi-state provider and entity enrollments, including Medicaid enrollments across multiple states.

Qualifications

• Minimum of 3 years of payer enrollment experience in a healthcare setting.
• Experience enrolling both individual providers and healthcare entities.
• Strong understanding of payer enrollment requirements, credentialing processes, and provider lifecycle management.
• Experience with multi-state Medicaid enrollments.
• Hands-on experience using CAQH, Availity, and PECOS.
• Strong knowledge of EFT enrollment processes and payer requirements.
• Ability to work independently and drive enrollments from application to approval.
• Excellent organizational skills with exceptional attention to detail.
• Strong problem-solving and critical-thinking abilities.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office Suite, including Word and Excel.
• Ability to maintain confidentiality and handle sensitive information appropriately.

Preferred Qualifications

• Experience managing multi-state provider and entity enrollments across a large geographic footprint.
• Experience working with multiple commercial, Medicare, and Medicaid payers.
• Experience with credentialing software and provider enrollment databases.
• Experience in an ambulatory surgery center (ASC) or healthcare services environment.

Knowledge, Skills & Abilities

• Clear understanding of credentialing systems and internal provider enrollment processes.
• Ability to take initiative and independently resolve enrollment issues.
• Strong relationship-building skills with payer representatives and internal stakeholders.
• Exceptional attention to detail and follow-through.
• Ability to manage competing priorities in a fast-paced environment.
• High degree of accountability, self-motivation, and ownership.

Work Environment

This position operates in a professional remote office environment and routinely uses standard office equipment, including computers, phones, and related technology.

Schedule

• Full-Time
• Monday through Friday
• Start time between 7:00 AM and 9:00 AM
• No weekends, holidays, or on-call requirements.

Travel

No travel is required for this position.

Benefits

• Remote work opportunity
• Competitive benefits package including medical, disability, and voluntary benefit plans
• Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA)
• 401(k) with company match
• Paid Time Off (PTO)
• Opportunity to work with a passionate, dedicated, and growing team focused on improving access to care

Work Location

Remote. Applicants must reside in one of the following states: AZ, CO, FL, ID, MD, MO, PA, SC, TN, or TX. Not eligible for California residents.