Analyst, Provider Enrollment

Position Summary

MDVIP is seeking a Provider Enrollment Analyst to manage the insurance provider enrollment process for our MDVIP physician affiliates. This role requires a deep understanding of credentialing & contracting procedures and the ability to provide accurate guidance and support to affiliated physicians, physician staff, and internal teams.

Key Responsibilities

• Credentialing & Contracting Coordination
• Manages non-standard provider enrollment workflows, interpreting payer-specific contract requirements and independently navigating complex scenarios that fall outside templated enrollment processes.
• Accountable for end-to-end provider enrollment and contracting coordination through completion, delivering responsive, high-quality service while proactively educating physicians on timelines, managing expectations, and maintaining strong partnerships as operational challenges arise.
• Serves as the primary liaison and subject-matter expert for provider enrollment, collaborating across physicians, internal stakeholders, and external partners to drive alignment, quality, operational readiness, and a consistently high standard of service across credentialing and contracting workflows.
• Completes statewide credentialing applications to establish new groups and add providers to commercial payers and Medicare.
• Maintains operational and regulatory integrity of provider enrollment data by independently managing, validating, and reconciling complex provider records across high-volume, payer-specific enrollment workflows.
• Exercises independent judgment to resolve enrollment obstacles and exceptions, escalating only high-risk, systemic, or time-sensitive issues with clearly defined solution options and impact assessments.
• Metrics & Reporting
• Develops, analyzes, and distributes timely, status reports to affiliated physicians and field staff; proactively manages follow-ups to ensure resolution and closure of all outstanding cases.
• Compiles, validates, and delivers comprehensive insurance-related reports and management presentations, translating complex data into clear insights to support decision-making and operational planning.
• Escalates & Urgent Issues
• Conducts detailed analysis and reconciliation of provider enrollment data to support accurate contracting, payer submissions, and ongoing network compliance, while managing complex, non-standard enrollment scenarios.
• Independently identifies, evaluates, and synthesizes complex enrollment and contracting issues, delivering clear root-cause analysis and actionable recommendations to management.
• Solves escalated issues and urgent requests.

Requirements

• Minimum Qualifications:
• Associate’s degree and at least two (2) years related business experience
• Four (4) years of related work experience
• Familiarity with EMR and credentialing software
• Proficient in Microsoft Office applications
• Preferred Qualifications:
• Experience with CAQH, PECOS & NPPES applications
• Experience with Net Docs, credentialing software, and athena
• Certified Provider Credentialing Specialist (CPCS)
• Certified Provider Enrollment Specialist (CPES)
• Experience with Salesforce or other CRM tools