Provider Enrollment & Payer Enrollment Analyst

Provider Enrollment & Payer Enrollment Analyst

Pinnacle Fertility is a leader in physician-centric fertility care, supporting high-performing fertility clinics and comprehensive service providers nationwide. Guided by our mission of fulfilling dreams by building families, Pinnacle offers compassionate care, innovative technology, and comprehensive fertility treatment services to provide patients with a seamless and personalized journey to parenthood.

The Provider Enrollment & Payer Enrollment Analyst supports Pinnacle Fertility's financial performance by ensuring providers, groups, and clinic locations are accurately enrolled and aligned with commercial and government payer requirements. This role is responsible for overseeing payer enrollment readiness, maintaining enrollment accuracy across systems and payer portals, and proactively identifying risks that could delay provider onboarding or impact reimbursement.

This position serves as a key resource for payer enrollment operations across the organization, partnering closely with credentialing vendors, Revenue Cycle, Operations, Contracting, and payer representatives to ensure timely enrollment submissions, issue resolution, and ongoing compliance with payer and regulatory requirements.

We are seeking a Provider Enrollment & Payer Enrollment Analyst to join our dedicated team at Pinnacle Fertility. This is a full-time, remote position, working Monday through Friday. This candidate must be located in MST or PST.

Key Responsibilities

• Manage provider and payer enrollment activities for new and existing providers, including demographic updates, group affiliations, location changes, revalidations, and payer roster maintenance.
• Track payer enrollment submissions, approvals, effective dates, and outstanding requirements to ensure providers are billing-ready.
• Maintain accurate provider, NPI, Tax ID, group, location, and payer records across internal systems and payer portals.
• Identify and escalate enrollment gaps or risks that may impact provider go-live dates, billing readiness, or reimbursement.
• Oversee credentialing vendor enrollment requests and monitor completion timelines, follow-up activity, and documentation.
• Communicate directly with payers to resolve enrollment discrepancies, denials, effective date issues, and payer setup concerns.
• Monitor payer and regulatory requirements, including revalidation cycles and payer-specific enrollment processes.
• Partner cross-functionally with Revenue Cycle, Credentialing, Billing, Operations, Coding, and Contracting teams to support enrollment readiness and payer issue resolution.
• Provide enrollment status updates and operational guidance for new providers, locations, and payer additions.
• Support fee schedule validation, reimbursement reviews, and payer research tied to enrollment or setup issues.
• Maintain enrollment tracking documentation and internal payer process resources.
• Other duties and projects assigned.

Position Requirements

• Education: Bachelor's degree in healthcare administration, business, or related field preferred; equivalent experience considered.
• Experience:
  • 35 years of provider enrollment or payer enrollment experience in healthcare required.
  • Experience managing commercial and government payer enrollment processes, including provider additions, revalidations, demographic updates, and issue resolution.
  • Experience working with credentialing vendors and payer portals preferred.
• Skills:
  • Strong organizational and tracking skills with the ability to manage multiple priorities and timelines.
  • Strong analytical and problem-solving skills.
  • Excellent communication and cross-functional collaboration abilities.
  • Familiarity with reimbursement methodologies, payer billing rules, CPT/HCPCS coding, or revenue cycle operations preferred.
  • Experience with fertility, specialty, or outpatient healthcare services preferred.

Compensation & Benefits

• Hourly Rate: $29.00 $38.00 per hour (final offers based on experience, skills, and qualifications).
• Benefits: Pinnacle Fertility offers a comprehensive benefits package including medical, dental, vision, and life insurance. Additional benefits include generous paid time off, paid holidays, and a retirement savings program. Further details will be provided during the interview process.

Diversity & Inclusivity at Pinnacle Fertility

At Pinnacle Fertility, we are committed to fostering a diverse, inclusive, and welcoming workplace. We are proud to be an equal opportunity employer and encourage applicants of all backgrounds, abilities, and life experiences to apply.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.