Provider Enrollment Specialist

About the role

The Provider Enrollment Specialist is responsible for ensuring healthcare providers are properly enrolled and credentialed with government and commercial payers to facilitate timely reimbursement. This role supports the organization by managing the provider enrollment process from application through approval, maintaining accurate provider records, and ensuring compliance with payer and regulatory requirements.

Responsibilities

• Prepare, submit, and track Medicare, Medicaid, and commercial payer enrollment applications for Radiologists and Radiology Group practices.
• Maintain up to 200 providers in a maintenance phase.
• Maintain accurate and current provider data in internal databases and payer systems.
• Maintain detailed and organized electronic files and records of all enrollment actions.
• Track application status and follow up with payers to ensure timely processing.
• Generate reports on enrollment status, expirations, and pending applications.
• Communicate with providers and internal departments to gather required documents and resolve enrollment-related issues.
• Respond to inquiries from payers and internal stakeholders regarding provider status.
• Ensure compliance with all payer-specific, federal, and state regulations related to enrollment and credentialing.
• Aid with audits, reporting, and documentation requests.

Requirements

• Detail-oriented with a high level of accuracy.
• Ability to interpret complex enrollment policies and payer guidelines and apply them to daily workflows.
• Problem-solving and escalation management skills.
• Strong customer service mindset when interacting with providers and stakeholders.
• Capacity to work independently and as part of a collaborative team.
• Ability to safeguard sensitive provider and organizational information in compliance with HIPAA regulations, ensuring confidentiality, security, and ethical management of sensitive information.

Skills and Experience

• Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
• Minimum 1-2 years of provider enrollment and credentialing experience, with at least 1 year in Medicare and Medical enrollment.
• Radiology and Teleradiology-specific experience highly preferred.
• Strong understanding of enrollment such as CMS, PECOS, NPPES, CAQH, Medical, Availity, etc.
• Familiarity with Medicare Part B and Medical fee-for-service and managed care enrollment rules.
• Exceptional organizational skills with the ability to manage multiple providers and deadlines.

Pay

The expected hourly range for this role is $23 to $29, based on your experience, skills, and geographic location. Depending on your qualifications, you may be considered for either a Provider Enrollment Specialist or Sr. Provider Enrollment Specialist title. Final compensation will be determined during the selection process and may vary accordingly.