Provider Enrollment Coordinator

About the role

The Provider Enrollment Coordinator is responsible for managing all aspects of provider enrollment and revalidation with federal, state, and commercial payers to ensure timely and accurate participation status. This role supports the onboarding lifecycle for physicians, advanced practice clinicians, and other healthcare providers by coordinating documentation, monitoring application progress, and communicating status updates to internal stakeholders and external agencies. The coordinator ensures compliance with organizational standards and payer-specific requirements, helping to prevent revenue disruption and optimize operational efficiency.

Responsibilities

Provider Enrollment & Payer Management (80%)

• Manage enrollment for 10 entities and several outside contract entities
• Prepare, submit, and track initial enrollment applications for MN and WI Medicare, MN and WI Medicaid, and contractual plans (profile, add/term/change forms, spreadsheets, and portals)
• Prepare and submit revalidations for MN and WI Medicare, MN and WI Medicaid, and commercial insurance plans
• Reassign providers with Medicare Part A for Critical Access Hospitals
• Handle provider maintenance including name changes, terminations, and change of practice locations
• Monitor approval timelines and proactively resolve enrollment delays or discrepancies
• Update CAQH, PECOS, NPPES, and contractual payer plan databases
• Conduct re-attestation of provider data every 120 days to ensure accuracy for contractual plans
• Enroll providers with out-of-state Medicaid based on state-specific requirements
• Add assigned plan codes in EPIC once confirmation is received after provider enrollment

Onboarding Support (10%)

• Collaborate closely with recruitment teams, credentialing, and Clinic Operations to ensure alignment of start dates and enrollment readiness
• Assist providers with completing payer-required documentation and signatures
• Serve as an enrollment subject matter expert for leadership, recruiters, and clinic teams
• Deliver a positive, professional onboarding experience for providers

Data Integrity & Compliance (10%)

• Ensure all enrollment processes follow federal/state regulations, payer guidelines, and organizational policies
• Maintain accurate digital records of applications, correspondence, approvals, and effective dates
• Support audits, quality reviews, and process improvement initiatives

Requirements

Minimum Qualifications

• High school diploma or equivalent
• 2+ years of experience in provider enrollment, medical staff services, credentialing, or revenue cycle operations
• Strong knowledge of Medicare/Medicaid enrollment processes and commercial payer requirements
• Excellent organizational skills and attention to detail
• Ability to manage multiple deadlines and shift priorities
• Strong communication skills and comfort interacting with providers and payer representatives

Preferred Qualifications

• Associate or bachelor's degree in business, healthcare administration, or related field
• Experience with CAQH, PECOS, NPPES, and common credentialing/enrollment software systems

Benefits

HealthPartners offers a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. The goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

About Us

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work. We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world. At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.