Payer Enrollment Specialist

Job Description

Job Description

Theoria Medical is seeking a highly organized and detail-oriented Payer Enrollment Specialist to support provider enrollment activities across Medicare, Medicaid, and commercial payers nationwide, with a strong emphasis on commercial payer enrollments.

This is a hands-on role focused on the day-to-day execution of provider enrollment activities. The ideal candidate enjoys owning the enrollment process from start to finish, proactively managing applications, following up with payers, and ensuring providers are successfully enrolled in a timely manner.

This fully remote role is responsible for preparing, submitting, tracking, and maintaining payer enrollment applications to ensure providers are enrolled accurately and efficiently. The ideal candidate will have hands-on experience managing enrollment processes, proactively following up with payers, resolving application issues, and maintaining provider data across credentialing and enrollment systems.

Success in this role requires strong attention to detail, the ability to manage multiple enrollments simultaneously, and a commitment to driving applications through completion.

About Us Theoria Medical is leading the charge in healthcare innovation, bringing multispecialty provider services and forward-thinking technology to skilled nursing facilities across the country.

What You'll Do

• Prepare, submit, and track provider enrollment and revalidation applications with commercial, Medicare, and Medicaid payers.
• Manage enrollment workflows to ensure providers are enrolled accurately and within established timelines.
• Maintain provider records and enrollment data in credentialing and enrollment systems.
• Complete and maintain CAQH profiles, attestations, and supporting documentation.
• Communicate directly with payers to obtain status updates, resolve deficiencies, and facilitate timely application processing.
• Identify and resolve enrollment issues, missing documentation, and payer rejections.
• Partner with internal teams to collect required provider information and support onboarding efforts.
• Monitor enrollment expirations, revalidations, and payer-required updates.
• Ensure compliance with payer requirements, regulatory standards, and organizational policies.
• Support process improvement efforts that increase enrollment accuracy and efficiency.

What We're Looking For
Required

• 3+ years of hands-on provider enrollment, payer enrollment, or credentialing experience.
• Demonstrated experience preparing and submitting enrollment applications for medical providers.
• Strong experience with commercial payer enrollments.
• Experience maintaining and managing CAQH provider profiles.
• Experience tracking enrollment statuses and resolving enrollment-related issues.
• Strong organizational skills and exceptional attention to detail.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong written and verbal communication skills.

Preferred

• Experience supporting multi-state provider enrollments.
• Experience with credentialing and provider enrollment platforms such as CAQH, Medallion, or similar systems.
• Experience with Medicare and Medicaid enrollment processes.
• Prior medical provider enrollment experience.

What Success Looks Like

• Enrollment applications are submitted accurately and on time.
• Provider onboarding is completed with minimal delays.
• Enrollment deficiencies and payer rejections are resolved efficiently.
• Provider records remain accurate, current, and audit-ready.
• Strong communication and follow-through with internal stakeholders and external payers.

Benefits

• 401(k) with employer match
• Health, dental, and vision insurance
• PTO and paid holidays
• Life insurance coverage
• Remote work flexibility

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