Position Summary
The Provider Enrollment Specialist is responsible for maintaining accurate, clean, and audit-ready data across all payer enrollment systems and workflows. This role supports the Credentialing and Payer Enrollment department and reports to the Credentialing Manager.
This position owns enrollment data from application through payer acceptance, ensuring work moves efficiently through the pipeline and to the payer. The ideal candidate is highly detail-oriented, process-driven, and experienced in provider enrollment, credentialing, payer portals, and data management.
MUST have experience in high-volume healthcare credentialing.
Key Responsibilities
- Maintain and audit Smartsheet reference tables, trackers, and reporting tools to ensure data accuracy.
- Review payer rosters on a scheduled basis and resolve discrepancies, missing providers, or outdated information.
- Maintain payer fee schedules, process fee update requests, and track effective dates.
- Organize enrollment applications, mappings, and supporting documentation.
- Manage application mapping and request new applications as needed.
- Process non-par provider arrangements and requests through completion.
- Process provider termination requests from payer panels, including effective dates, confirmations, and offboarding-related updates.
- Track expiring provider credentials, licenses, and payer re-credentialing dates to support timely renewal and uninterrupted enrollment.
- Identify and escalate data integrity issues that may impact billing, operations, or downstream workflows.
- Provide additional team support as needed.
Performance Expectations
- Keep Smartsheet data, rosters, fee schedules, and enrollment records accurate and audit-ready.
- Process requests timely and accurately, including terminations, non-par requests, fee updates, and applications.
- Independently identify, diagnose, and resolve issues while escalating key discrepancies promptly.
Qualifications
Education & Experience
- Minimum 5 years of experience in provider enrollment, credentialing, or payer relations required.
- Certified Provider Credentialing Specialist certification preferred.
Required Skills
- Strong knowledge of payer enrollment processes, application types, and payer portal navigation.
- Proven ability to maintain accurate data across multiple systems.
- Ability to manage high-volume work while meeting deadlines.
- Strong written and verbal communication skills.
- Ability to work independently in a fully remote environment with minimal supervision.
Systems Experience
- Smartsheet experience preferred, especially with reference tables and trackers.
- Intermediate Microsoft Excel skills required, including filters, sorting, and basic formulas.
- Adobe Acrobat experience required.
- DocuSign, Dentrix, and payer portal experience preferred.
Core Competencies
- Data accuracy and ownership
- Strong attention to detail
- Accountability and follow-through
- Process discipline
- Independent work ethic
- Clear and professional communication
Work Environment
This is a fully remote, individual contributor role with no direct reports. A reliable high-speed internet connection is required. The role is primarily sedentary and requires extended periods of computer and screen use. Team members are expected to be camera-on and professionally presentable during video calls and virtual meetings.
