Payer Enrollment Specialist

Key Responsibilities

• Manage payer enrollment and credentialing processes for healthcare providers across both delegated and non-delegated environments.
• Cook up provider onboarding, credentialing, and payer enrollment from initial submission through completion.
• Maintain accurate and timely payer enrollment information, tracking statuses, deadlines, renewals, and outstanding requirements.
• Manage enrollment activities within a non-delegated environment, ensuring all payer requirements and deadlines are met.
• Support and maintain delegated credentialing processes and ensure providers remain compliant with applicable requirements.
• Review and assess provider credentials, licenses, certifications, and other documentation for completeness and compliance.
• Manage enrollment and credentialing activities for a large provider population, including employee, source/WK1, and agency providers.
• Work within a high-volume, highly regulated, and heavily audited healthcare environment, maintaining exceptional attention to detail and accuracy.
• Utilize Excel to track, organize, and manage large amounts of provider and enrollment data.
• Partner with internal teams, healthcare providers, and payers to resolve enrollment and credentialing issues.
• Maintain organized documentation and records to support audits, compliance requirements, and ongoing provider participation.

Qualifications

• 3+ years of experience in healthcare payer enrollment, credentialing, revenue cycle, or related healthcare administration.
• Prior experience in a healthcare office, administrative, customer service, or related healthcare environment.
• Knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• Experience with provider credentialing, revenue cycle, payer enrollment, or medical office operations.
• A strong understanding of provider enrollment requirements, documentation, and compliance.
• Excellent organizational skills with the ability to manage multiple providers, payers, deadlines, and priorities.
• A strong attention to detail and accuracy, particularly in an audit-driven environment.
• Strong Excel skills and the ability to work with and track large volumes of data.
• Excellent written and verbal communication skills.
• The ability to work independently while also collaborating effectively with internal teams.

Preferred Qualifications

• CPMSM, CPCS, CPES, or another related healthcare credentialing/enrollment certification is preferred but not required.
• Experience managing enrollment and credentialing for a large provider population is highly valued.
• Experience working in a delegated and non-delegated environment is a plus.