About the Role
The specialist manages enrollment processes for healthcare providers in electronic data interchange systems, ensuring compliance, accuracy, and timely setup for claims submission.
Responsibilities
- Verify provider documentation for accuracy and completeness
- Submit enrollment applications to insurance payers
- Track enrollment status across multiple payer systems
- Respond to payer inquiries regarding provider submissions
- Maintain up-to-date knowledge of payer enrollment requirements
- Correct and resubmit rejected enrollment applications
- Coordinate with internal teams to resolve documentation gaps
- Ensure compliance with federal and state regulations
- Update provider records in internal databases
- Communicate timelines and requirements to stakeholders
- Follow up on pending enrollments to prevent delays
- Assist with audits related to provider credentialing
- Monitor changes in payer policies affecting enrollment
- Support onboarding of new providers into billing systems
- Maintain confidentiality of provider and patient information
- Process re-enrollments and revalidations as required
- Troubleshoot technical issues with enrollment portals
- Escalate complex cases to senior staff when needed
- Ensure timely activation of electronic claims submission
- Provide status updates to operations and provider success teams
Nice to Have
- Certified Healthcare Access Associate (CHAA) credential
- Experience with CAQH enrollment platform
- Knowledge of Medicare and Medicaid enrollment rules
- Background in provider enrollment for home health or hospice
- Familiarity with National Provider Identifier (NPI) registration
- Experience using EHR platforms such as AthenaNet or Epic
Compensation
Competitive hourly rate
Work Arrangement
Remote
Team
Part of the onboarding and compliance team supporting healthcare providers
Why This Role Matters
Accurate provider enrollment is essential for patients to receive care without billing interruptions. This role directly impacts access to services by ensuring providers are set up correctly and promptly in insurance networks.
What You’ll Do Every Day
Review provider applications, submit to payers, track responses, correct errors, and confirm activation. You’ll act as a key link between clinical teams and insurance systems to maintain seamless operations.
Not available
