Provider Enrollment Specialist II

Responsibilities Payer Enrollment & RCM‑Aligned Manage and coordinate all aspects of payer enrollment for new and existing providers, including tracking progress, deadlines, and payer requirements. Verify group‑level versus provider‑level contracts to confirm enrollment steps required by each payer. Complete and submit payer enrollment applications (including signature‑required forms) and perform proactive follow‑up to expedite approvals. Utilize payer portals to submit information, track status, manage rosters, and complete provider demographic updates, location changes, and revalidations. Utilize Athena practice management to identify enrollment issues and complete tasks related to provider configuration. Communicate provider changes to contracted health plans and FCS, AMGR, and AMGBA management via standardized reports. Government Payer Maintenance (CMS / DHCS) Manage Medicare revalidation cycles and submit updates through PECOS. Perform annual Medi‑Cal renewals and maintain records in PAVE. EHR & System Collaboration Work within the EHR/practice management system (Athena) to identify, troubleshoot, and resolve enrollment‑related issues. Collaborate with IT/EHR analysts, Revenue Cycle, and Operations to correct provider setup, payer participation mapping, NPI/taxonomy assignments, and other configuration components required for clean claim submission. Independently troubleshoot complex EHR enrollment errors to prevent billing delays. Credentialing & Recredentialing Process credentialing and recredentialing applications accurately and promptly in accordance with FCS, AMGR, and AMGBA policies, health plan delegation requirements, and NCQA standards. Track and maintain renewal‑based provider credentials, including licenses, DEA registrations, board certifications, malpractice coverage, and other compliance documents. Disseminate new or modified professional information to FCS, AMGR, and AMGBA providers and departments; coordinate tasks in tickler systems to ensure follow‑up and timely completion. Data Management, Compliance & Audits Accurate input, updates, and modifications to the credentialing database; perform routine audits to assure accuracy. Review state and federal sanctions bulletins and update provider files accordingly. Prepare materials for external audits by payors and governmental agencies; ensure files remain audit‑ready. Maintain records across internal databases, CAQH, PECOS, PAVE, payer portals, and contract files. Administrative Coordination & Communication Coordinate responses to payer inquiries; follow up with payers and providers to completion. Maintain effective communication with health plan representatives and AMG departments. Participate in training sessions related to payer enrollment and credentialing workflows; collaborate with team members to meet weekly enrollment goals. Qualifications & Experience High school diploma or equivalent. 3–5 years of healthcare credentialing and payer enrollment experience; IPA, physician group, or Revenue Cycle experience preferred. Excellent computer skills, including Microsoft Office (Word, Outlook, Excel, PowerPoint). Ability to use independent judgment and initiative within established policies and procedures. Strong relationship‑building skills across all levels of staff, management, and external payer contacts. Excellent written and verbal communication skills. Exceptional organizational skills and the ability to manage multiple projects concurrently. Ability to obtain, synthesize, and analyze data and recommend solutions. Ability to draft presentations, handouts, and communications. Demonstrates a learning and growth mindset; proactive and solution‑oriented. Preferred Certifications Certified Provider Credentialing Specialist (CPCS) preferred. National Association Medical Staff Services (NAMSS) coursework or certification preferred. Salary & Benefits Base Salary: $21.00 – $25.00/hr. Competitive compensation package recognizing experience, credentials, and education. Medical, vision, and dental coverage. 401k savings plan with a company match. Flexible time off and 9 paid holidays. Additional Requirements Background check and drug screen required for external hires. Qualified applicants with arrest records and/or conviction records will be considered in accordance with Federal, State and local laws, including the San Francisco Fair Chance Ordinance. EEO Statement All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. #J-18808-Ljbffr