[Hiring] Provider Enrollment Specialist @NATIONAL PARTNERS IN HEALTHCARE

Role Description

The Provider Enrollment Specialist is responsible for managing the enrollment and revalidation of healthcare providers with government and commercial payers. This role ensures accurate and timely submission of enrollment applications, maintenance of provider records, and compliance with payer, regulatory, and organizational requirements. The Specialist serves as a key liaison between providers, payers, and internal departments to resolve enrollment issues, prevent claim delays, and support uninterrupted reimbursement. Strong attention to detail, knowledge of payer guidelines, and effective communication skills are essential to success in this role.

Essential Duties and Responsibilities

• Prepare, submit, and track provider enrollment, revalidation, and recredentialing applications with government and commercial payers (e.g., Medicare, Medicaid, commercial insurance plans).
• Maintain current and accurate provider demographic, licensure, certification, and contract information in enrollment systems, credentialing databases, and payer portals.
• Serve as the primary point of contact for providers regarding enrollment status, documentation requirements, timelines, and payer correspondence.
• Review enrollment applications for completeness, accuracy, and compliance with payer and regulatory requirements prior to submission.
• Communicate regularly with payer representatives to resolve application discrepancies, follow up on pending submissions, and address denials or terminations.
• Coordinate with internal departments such as credentialing, billing, compliance, and contracting to ensure alignment of provider data and minimize claim rejections.
• Monitor enrollment statuses and proactively identify and resolve issues that could delay provider activation or disrupt reimbursement.
• Maintain thorough documentation of enrollment activities, correspondence, and approvals in accordance with organizational policies and audit standards.
• Ensure timely revalidation and recredentialing to prevent lapses in payer participation.
• Stay current on payer enrollment guidelines, CMS regulations, and industry best practices to ensure ongoing compliance.
• All other duties as assigned.

Qualifications

• Excellent computer, data entry, and clerical skills.
• Knowledge of business office procedures required.
• Excellent interpersonal, clerical, telephone, and communication skills.
• Ability to multi-task and deal effectively with a variety of situations requiring judgment and poise.
• Attention to detail and organizational abilities are essential.
• Demonstrated working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred.
• Two plus years of experience in payer credentialing required.

Requirements

• Associate’s degree in Business Administration (BA) or related field, or equivalent combination of education and experience required.
• Two years of credentialing experience required.
• A minimum of two to five years’ experience and proven proficiency in provider enrollment payer credentialing required.

Benefits

• Base pay is based on market location and will vary depending on job-related knowledge, skills, and experience.
• Full-time positions are eligible for a discretionary bonus and a comprehensive benefits package.