Provider Enrollment Specialist

The Provider Enrollment Specialist facilitates the physician and mid-level enrollment applications process for Medicare, Medicaid, and commercial payers. This role is responsible for preparing and submitting supporting documentation for the purpose of enrolling individual physicians and mid-levels. This position is also responsible for follow up on the status of applications and tracking the progress on all pending applications.Prepares Enrollment Documentation and Applications – 80%Initiates the payer enrollment process with all payers identified by client for enrollmentCompletes all required applications for submission to payersCoordinates credentialing data needed for enrollment, contracting, and other related purposesCreates providers in CAQH ProView as necessaryEnters and updates clinician information in the databaseCollects, monitors, and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvementFocuses on enrollment related continuous process improvement to ensure optimal operationInternal and External Liaison - 20%Acts as liaison to CVO, clients, outside agencies, physicians, medical practice groups, health plans, etc.Responds to internal and external inquiries on routine enrollment and contract mattersWorks closely with clinicians to obtain missing documentation pertaining to provider enrollmentSECONDARY FUNCTIONS (IF APPLICABLE)May work on special projects or other duties as assignedSUPERVISORY/BUDGETARY/EXTERNAL COMMUNICATION RESPONSIBILITYMay communicate with clinicians, clients, and insurance providersQUALIFICATIONS – EDUCATION, WORK EXPERIENCE, CERTIFICATIONSHigh School Diploma or equivalent required. Bachelor’s Degree preferred.3+ years of related experience requiredKNOWLEDGE, SKILLS, AND ABILITIESAbility to adhere to and exhibit the Company Values at all timesWorking knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and TeamsWorking knowledge of CMS, PECOS, CAQH, NPPES payer credentialing softwareWorking knowledge of PDF editing softwareWorking knowledge of SalesforceAbility to build relationships at all levels - internally and externallyStrong customer service mindsetStrong organizational and time management skillsAbility to work independentlyStrong communication skills - both oral and writtenAbility to work with sensitive information and maintain confidentialitySolid critical thinking and problem-solving skillsStrong attention to detail and accuracyKEY COMPETENCIES REQUIREDBusiness InsightInterpersonal SavvyCustomer FocusCommunicates EffectivelyBalances StakeholdersOrganizational SavvyAction OrientedInstills TrustResourcefulnessSituational AdaptabilityCollaboratesPHYSICAL, MENTAL, WORKING CONDITION, AND TRAVEL REQUIREMENTSTypical office environment - sedentary with typing, writing, reading requirementsMay be able to sit or standSpeaking, reading, writing, ability to use a telephone and computerAbility to exert up to 10 lbs. of force occasionallyAbility to interpret various instructionsAbility to deal with a variety of variables under only limited standardization

Created: 2025-07-15