Provider Enrollment Specialist

Provider Enrollment Specialist

Coordinates provider enrollment for physician/allied health professional participation in all government and third party payers for all billing sites for which the division is responsible.

Education and Experience Required:

High School diploma or GED required. Two (2) years of healthcare claims insurance, Provider Enrollment or credentialing experience. Minimum speed of 35 words per minute on typing test. The department has the right to specify higher typing requirements.

Certifications, Licenses, or Registration Required: N/A

Knowledge, Skills, and Abilities:

Coordinates provider enrollment for physician/allied health professional participation in all government and third party payers for all billing sites for which the division is responsible.

Excellent organization and time management skills with the ability to handle multi-tasks. Excellent verbal and written communication skills must have excellent computer skills (word-processing, database management, and spreadsheet).

Responsibilities:

• Prepares provider applications for third party payers.
• Coordinates correspondence to carriers and billing agent to expedite provider number assignments.
• Coordinates delivering provider applications to appropriate health plans including adherence to strict deadlines and procedures.
• Performs follow-up with health plans in order to expedite participation approval by each health plan.
• Maintains systems to identify and disseminate information to others regarding status of health plan participation.
• Coordinates with insurance carriers to maintain the most current applications and processes for enrollment. Coordinates, completes, and follows-up on the revalidation process for contracted payers.
• Insures current information is on file for all contracted physicians and all pertinent documentation is forwarded to appropriate third party payers.
• Maintains provider number records, personal adherence to professional confidentiality standards established within the department and in accordance with legal, ethical, payor organization practices and policies.
• Participates in an integrated work team as a responsible team member, follows the established department processes concerning communication, production, efficiency, conflict resolution, decision-making, problem-solving, and interpersonal relations.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands Requires occasional working hours significantly beyond regularly scheduled hours, occasional activities subject to significant volume changes of a seasonal/clinical nature, occasional bending, occasional lifting and carrying up to 25 pounds, occasional crouching/stooping, occasional driving, occasional kneeling, occasional reaching, constant sitting, frequent standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Time Type: Full time

FLSA Designation/Job Exempt: No

Pay Class: Hourly

FTE %: 100

Work Shift: Day

Benefits Eligibility: Grant Funded: No

Job Posting Date: 05/7/2026

Job Closing Date (open until filled if no date specified):