Enrollment Specialist

Current employees: apply via the internal career site in Workday.

About the role

The Enrollment Specialist audits credentials verifications to meet NCQA Accreditation standards and handles payer enrollment for facilities, service locations, professional groups, physicians, practitioners, and other billing providers. This role ensures accurate plan participation status is shared with internal departments to maximize collections in the revenue cycle. The specialist serves as a subject-matter expert for payer credentialing and enrollment, ensuring providers are fully credentialed with all applicable government and commercial payers.

Responsibilities

• Oversee and collect accurate credentialing for organizational providers, facilities, and ancillary services.
• Gather documentation for payer enrollment of complex hospital groups and services, ensuring compliance with hospital policies and accreditation standards (NCQA, CMS, etc.).
• Ensure compliance with regulatory requirements, accreditation standards, payer policies, and governing documents.
• Obtain application signatures, submit applications, and follow up diligently to ensure timely processing. Respond to deficiency notifications promptly.
• Monitor and follow up on provider addition requests, communicate changes/corrections/terminations, and identify process improvements.
• Collaborate with Legal and Accreditation teams to meet regulatory and compliance requirements.
• Interpret and ensure compliance with delegated credentialing policies, conduct annual payor credentialing file audits, and oversee delegated credentialing roster submission and tracking.
• Work with delegated payer contacts to address concerns and cultivate relationships.
• Promote data integrity within the Credentialing database and support implementation of new database modules, including data migration, validation, and mapping.
• Provide training to enhance team knowledge and skills related to payer enrollment.
• Maintain positive working relationships with payer representatives, providers, and internal departments.
• Perform other duties as assigned.

Requirements

• High School Diploma or GED equivalent.
• Minimum 1 year of healthcare experience (e.g., Credentialing/Enrollment, Billing/Collections, Business Office).

Preferred: Associate’s or Bachelor’s degree in Healthcare or Business.

Skills

• Excellent interpersonal skills and ability to work efficiently with internal and external customers.
• Sedentary work: Exerting up to 10 pounds of force occasionally; primarily sitting.

Benefits

• Supportive work culture.
• Medical, vision, and dental coverage.
• Retirement plans, Health Savings Account, and Flexible Spending Account.
• Instant pay for qualifying positions.
• Paid Time Off accrual bank.
• Opportunities for growth and advancement.
• Tuition assistance/reimbursement.
• Excellent pay differentials on qualifying positions.
• Flexible scheduling.

Pay

$20.96 – $26.20 per hour (determined by knowledge, skills, and experience).

Schedule

16 scheduled weekly hours; requires availability for assigned shifts.