Provider Enrollment Specialist with RCM focus
Department: Credentialing
Reports To: Director of Revenue Cycle
Location: In-office
We are seeking a highly motivated and detail-oriented Provider Enrollment Specialist with Revenue Cycle Management focus to join our Revenue Cycle department. This position is responsible for all aspects of provider and facility payer enrollment while serving as the operational bridge between Credentialing, Contracting, and Revenue Cycle Management (RCM).
The ideal candidate will possess a strong background in payer enrollment, provider contracting, and healthcare revenue cycle operations. This individual must understand how enrollment and credentialing directly impact claim reimbursement and have hands-on experience investigating and resolving payer denials resulting from enrollment, credentialing, contracting, and provider data issues.
This role requires an individual proactively working with Revenue Cycle teams to minimize revenue loss caused by enrollment-related issues. Success in this role requires exceptional follow-through, strong analytical skills, and the ability to independently identify root causes, resolve payer issues, and prevent future denials.
Responsibilities
Revenue Cycle and Denial Resolution
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Serve as the subject matter expert for payer enrollment and credentialing-related claim denials.
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Review and work enrollment-related denials received from Revenue Cycle teams to identify root causes and implement corrective actions.
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Research payer denials involving provider participation, effective dates, credentialing status, taxonomy, billing group assignments, contracting discrepancies, or enrollment errors.
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Partner closely with Billing, Coding, Patient Accounts, Contracting, and Revenue Cycle leadership to resolve enrollment issues impacting reimbursement.
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Coordinate timely claim corrections and resubmissions after enrollment issues have been resolved.
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Identify recurring denial trends and recommend process improvements to reduce future enrollment-related denials.
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Assist with root cause analysis for enrollment failures impacting reimbursement and responsible for developing preventive solution
Contracting Support
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Collaborate with the Contracting team to ensure provider enrollments align with executed payer agreements and contract effective dates.
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Understand payer contract implementation requirements and ensure providers are enrolled under the appropriate networks and products.
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Review contract participation requirements that impact provider enrollment and reimbursement.
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Assist in coordinating payer implementations for newly executed contracts and acquisitions.
Minimum Qualifications
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Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
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Minimum 3–5 years of provider enrollment experience.
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Minimum 2 years of Revenue Cycle Management (RCM), billing, accounts receivable, or payer denial resolution experience.
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Working knowledge of provider contracting and payer implementation processes.
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Demonstrated experience investigating and resolving credentialing, enrollment, and contracting-related claim denials.
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Strong understanding of Medicare, Medicaid, and commercial payer enrollment requirements.
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Experience working with provider enrollment systems, payer portals, and credentialing software.
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Proficiency with CAQH ProView, PECOS, NPPES, and payer-specific enrollment systems.
Preferred Qualifications
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Previous experience working in both Credentialing and Revenue Cycle Management.
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Experience with payer contracting or provider network management.
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Experience supporting physician practices, nephrology groups, dialysis organizations, or multi-specialty healthcare organizations.
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Experience with delegated credentialing and payer roster management.
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Knowledge of claim adjudication and payer reimbursement methodologies.
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Credentialing certification (NAMSS CPCS or CPMSM) preferred but not required.
Skills & Competencies
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Strong understanding of how provider enrollment, credentialing, contracting, and payer participation impact claims processing and reimbursement.
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Ability to independently investigate enrollment-related denials and identify root causes.
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Working knowledge of healthcare billing, payer claim adjudication, and denial management processes.
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Strong analytical and critical thinking skills with a proactive problem-solving approach.
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Exceptional organizational skills with the ability to manage multiple priorities and meet deadlines.
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Excellent attention to detail and accuracy when maintaining provider and payer information.
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Ability to collaborate effectively across Credentialing, Contracting, Revenue Cycle and Provider Operations.
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Excellent written and verbal communication skills.
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Strong initiative, accountability, and ownership of assigned work.
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High level of professionalism and discretion when handling confidential information.
About NANI
NANI is the nation’s largest Nephrology practice. We have provided excellence in specialty kidney care for over 50 years. NANI’s nephrology practices are primarily operated in northern Illinois and throughout northern and central Indiana, with additional locations in New Jersey. NANI’s scope of care and services include difficult-to-control hypertension, kidney disease, kidney injury, kidney transplant, and related services, as well as groundbreaking and lifesaving clinical research and consulting services.
Mission: To transform the lives of people living with kidney disease by providing the highest quality care.
