Provider Enrollment Specialist

The Provider Enrollment Specialist coordinates Medicare and Medicaid enrollment/re-enrollment, as well as managed care credentialing and contracting processes for healthcare providers. This role serves as the administrator for the billing system, assists practices with system issues, maintains NPI files and provider numbers, and acts as a customer service liaison. The specialist also monitors accounts receivable to maintain appropriate levels, reviews payments to maximize reimbursement, and interacts with patients, insurance carriers, billing vendors, and practice personnel regarding patient accounts.

All functions are performed in a courteous and professional manner.

• Collect and maintain provider data for Medicare and Medicaid enrollment.
• Prepare and submit applications for new provider enrollments and updates; follow up with carriers regarding application status.
• Ensure compliance with Medicare and Medicaid provider enrollment guidelines.
• Request and maintain NPI numbers for providers and clinics.
• Follow up with insurance companies and patients regarding outstanding claims and appeals.
• Generate reports to identify issues with provider numbers and non-payment.
• Communicate relevant information to appropriate personnel.
• Educate staff on corrections (e.g., front-end entry errors) in a constructive manner.
• Collect and review managed care contracts for accurate billing and payment terms.
• Identify problem accounts and ensure resolution.
• Review Athena correspondence and address issues as needed.

• High School Diploma (proof of education required).
• 1–3 years of experience in payer enrollment.
• Solid knowledge of PC applications, including Word, Excel, and Access.

• Experience with healthcare billing systems (e.g., Athena).
• Prior exposure to managed care contracting and credentialing processe s.

• None required; relevant certifications in healthcare administration or billing are a plus.