Provider Enrollment Specialist

Provider Enrollment Specialist

Sigma Inc. is currently seeking a detail-oriented and experienced Provider Enrollment Specialist to join our onsite team in Irving, TX. This role is responsible for coordinating provider enrollment, credentialing, and billing system support while ensuring compliance with regulatory standards.

Job Summary

The Provider Enrollment Specialist coordinates Medicare and Medicaid enrollment and re-enrollment, manages provider credentialing and contracting, and supports billing system administration. This role also serves as a liaison between providers, insurance carriers, patients, and internal teams to ensure accurate billing, reimbursement, and compliance.

Key Responsibilities

• Manage Medicare and Medicaid provider enrollment and re-enrollment processes
• Prepare, submit, and track provider enrollment applications and updates
• Follow up with insurance carriers regarding application status via phone or written communication
• Maintain and update NPI (National Provider Identifier) files and provider records
• Ensure compliance with Medicare and Medicaid enrollment guidelines
• Monitor and follow up on outstanding claims, appeals, and accounts receivable
• Analyze reports to identify billing issues, non-payment trends, and claim discrepancies
• Serve as a customer service liaison between patients, insurance carriers, billing vendors, and clinic staff
• Review payments and contracts to ensure accurate reimbursement and billing terms
• Assist with billing system administration, troubleshooting, and training
• Act as a Superuser for billing systems (e.g., Athena) to support clinic staff
• Review correspondence, unpostables, and resolve problem accounts
• Educate staff on billing corrections and front-end data entry improvements
• Participate in credentialing meetings, training sessions, and system updates
• Maintain strict compliance with HIPAA regulations and confidentiality standards
• Support organizational policies, quality assurance, and safety standards
• Perform additional duties as assigned

Required Qualifications

• High School Diploma or equivalent
• 13 years of payer enrollment or provider enrollment experience
• Knowledge of Medicare, Medicaid, and managed care enrollment processes
• Proficiency in Microsoft Office (Word, Excel, Access)
• Strong understanding of billing systems and claims processing
• Excellent written and verbal communication skills
• Strong organizational, analytical, and problem-solving abilities
• Ability to work collaboratively and interact with all levels of staff and management

Preferred Qualifications

• Experience with Athena or similar billing systems
• Familiarity with credentialing and managed care contracts
• Prior experience in healthcare administration or provider services