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A healthcare software company helping you deliver whole-person, value-based care.
Provider Enrollment Specialist
Location
United States
Posted
49 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Provider Enrollment Specialist
Netsmart
Role Description We are seeking a detail‑oriented Provider Enrollment Specialist to support our Revenue Cycle Management (RCM) operations. This role is responsible for managing the full lifecycle of provider enrollment and re‑enrollment across government and commercial payers. The ideal candidate understands how timely and accurate enrollment directly impacts revenue, provider readiness, and patient access to care. This position works closely with internal billing teams, provider offices, and payer representatives to ensure enrollment requirements are met efficiently and compliantly. Key Responsibilities - Manage the end‑to‑end provider enrollment, re‑credentialing, and revalidation process for Medicare, Medicaid, and commercial payers - Prepare, submit, and track enrollment applications, ensuring accuracy and completeness - Maintain and update provider information within CAQH, PECOS, payer portals, and internal tracking systems - Conduct follow‑ups with payers to resolve enrollment delays, denials, or discrepancies - Partner with billing and operations teams to prevent enrollment‑related claim delays or revenue disruptions - Support new provider onboarding by ensuring enrollment approvals are secured prior to billing - Monitor payer guidelines and enrollment requirements, staying current on regulatory changes - Maintain clear documentation and reporting on enrollment status and timelines - Assist with audits, revalidations, and payer correspondence as needed Qualifications - 1+ years of experience in provider enrollment, credentialing, or revenue cycle management - Working knowledge of Medicare, Medicaid, and commercial payer enrollment processes - Experience using CAQH, PECOS, NPI Registry, and payer portals - Strong attention to detail with the ability to manage multiple enrollments concurrently - Effective written and verbal communication skills - Ability to work independently while collaborating across teams - Proficient in Microsoft Office Platforms (Word, Excel, Outlook, etc.) Preferred Qualifications - Experience supporting multi‑provider or multi‑state healthcare organizations - Familiarity with enrollment tracking systems or RCM platforms - Understanding of downstream billing and claims workflows - Revenue cycle or healthcare certifications (CPC, CPB, or similar) are a plus Benefits - Direct impact on provider readiness and revenue performance - Exposure to multiple payer types and healthcare specialties - Opportunities for growth within enrollment, credentialing, or broader RCM functions - Collaborative team environment focused on process improvement and operational excellence
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