Provider Enrollment Specialist

About the role

CEC Healthcare, a not-for-profit Federally Qualified Health Center (FQHC), is seeking a Provider Enrollment Specialist to join their team. This position plays a critical role in ensuring that healthcare providers are properly credentialed, enrolled, and maintained within Medicare, Medicaid, and commercial payer systems to support uninterrupted patient care and reimbursement processes.

Responsibilities

• Aid in initial credentialing, recredentialing, enrollment, and revalidation applications for Medicare, Medicaid (including NY eMedNY), and commercial insurance plans.
• Maintain accurate provider information within credentialing systems such as CAQH, PECOS, and NPPES.
• Track application status and proactively follow up with payers to ensure timely approvals.
• Verify and maintain provider licensure, board certifications, DEA registrations, malpractice coverage, education credentials, and other required documentation.
• Ensure timely provider revalidations in accordance with CMS and New York State Department of Health requirements.
• Maintain credentialing files in compliance with HRSA, FQHC, and audit standards.
• Collaborate with Human Resources, Compliance, and Clinical Leadership on provider onboarding and termination processes.
• Monitor provider enrollment status to minimize disruptions in billing and reimbursement.
• Support payer roster updates and enrollment changes.
• Stay informed of Medicare, Medicaid, and commercial payer regulatory updates.
• Respond to credentialing and enrollment inquiries from internal and external stakeholders.
• Maintain compliance with HIPAA privacy and security standards.
• Affiliate with departmental reporting, audits, and special projects as needed.

Qualifications

• High School Diploma or equivalent.
• Strong organizational skills and attention to detail.
• Proficiency with Microsoft Office Suite, including Excel, Word, and Outlook.
• Excellent written and verbal communication skills.

Preferred Qualifications

• Associate degree.
• At least one year of experience in provider enrollment, credentialing, medical staff services, healthcare administration, or a related field.
• Experience with Medicare and Medicaid enrollment processes, particularly New York State Medicaid/eMedNY.
• Familiarity with CAQH, PECOS, NPPES, and healthcare credentialing platforms.
• Knowledge of CMS, HRSA, and FQHC operational guidelines.

Skills & Competencies

• Ability to manage multiple priorities and meet deadlines.
• Strong analytical and problem-solving abilities.
• Ability to maintain confidentiality and handle sensitive information with discretion.
• Self-motivated with the ability to work independently and collaboratively.