- Prepare, submit and track payer enrollment applications for new providers and existing provider changes
- Maintain accurate records of enrollment activities in the credentialing system
- Communicate with insurance companies, healthcare providers and internal departments to ensure efficient application processing
- Monitor enrollment status and follow up with payers to resolve delays or issues
- Update provider demographic and practice information with contract payers
- Maintain recredentialing timelines and requirements to prevent enrollment lapses
- Collaborate with Field Support, Operations and Revenue Cycle Management teams to resolve escalated enrollment or credentialing issues
- Research and resolve out-of-network claims issues by investigating provider participation status and enrollment effective dates
- Coordinate temporary provider enrollments and complete required documentation, linkage and payer updates
- Collaborate with RCM on provider enrollment status and provide reports as needed
- Generate and maintain enrollment status reports
- Support audits and perform other duties as assigned
- Report to the Enrollment Manager
Requirements
- High school diploma or equivalent required
- Associate or Bachelor’s degree preferred
- 1–3 years of experience in payor enrollment
- Working knowledge of commercial payors and government payor requirements
- Proficient in Microsoft Office and credentialing software including CAQH and Availity
- Strong attention to detail, organization and follow-up skills
- Excellent communication and customer service abilities interacting with internal teammates and external clients
- Detail oriented, with strong analytical and problem-solving skills
- Experience working with multi-specialty large group practices preferred; dentistry is a plus
- Knowledge of revenue cycle and billing processes preferred
- Familiarity with NPI and file provider management preferred
Core Competencies
Demonstrates expertise in payer enrollment processes, including application preparation, tracking, and communication with insurance companies. Proficient in maintaining accurate records and resolving enrollment issues while ensuring compliance with credentialing requirements.
Highest-signal resume keywords
- Payer Enrollment Experience
- Credentialing Software Proficiency
- Attention to Detail
- Communication Skills
- Revenue Cycle Knowledge
ATS Optimization Keywords
Hard Skills
- Payer Enrollment
- Credentialing
- Provider Demographic Management
- Claims Resolution
- Data Reporting
Soft Skills
- Organization
- Follow-Up Skills
- Customer Service
- Analytical Skills
- Problem-Solving Skills
Industry Keywords
- Commercial Payers
- Government Payers
- NPI
- Multi-Specialty Practices
- Billing Processes
Tools & Technologies
- Microsoft Office
- CAQH
- Availity
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Provider Enrollment Specialist Arbeitgeber: Jobtailor
Als Front Office Supervisor in unserem dynamischen Team bieten wir Ihnen die Möglichkeit, in einem unterstützenden und freundlichen Arbeitsumfeld zu wachsen. Wir legen großen Wert auf die berufliche Entwicklung unserer Mitarbeiter und bieten regelmäßige Schulungen sowie die Chance, Verantwortung zu übernehmen. Unsere Lage ermöglicht es Ihnen, Teil einer lebendigen Gemeinschaft zu sein, während Sie gleichzeitig die Standards unseres Franchise-Partners einhalten und unseren Gästen einen unvergesslichen Aufenthalt bieten.
