Enrollment Specialist

Provider & Facility Enrollment

• Prepare, submit, and track provider and facility enrollment applications.
• Coordinate initial enrollments, revalidations, reactivations, changes of information, and terminations.
• Maintain enrollment records, supporting documentation, and required signatures.
• Monitor application status and follow up with payer organizations until completion.
• Research and resolve enrollment issues or application deficiencies to prevent delays.

Payer & Regulatory Compliance

• Maintain provider enrollment with Medicare, Medi-Cal, managed care plans, commercial payers, and other contracted health plans.
• Monitor enrollment deadlines and revalidation requirements.
• Ensure compliance with federal, state, payer, and organizational requirements.
• Maintain confidentiality of provider and organizational information.

Collaboration & Communication

• Serve as the primary point of contact for enrollment-related questions.
• Collaborate with Human Resources, provider leadership, Revenue Cycle, Finance, and contracted payers.
• Communicate enrollment status updates and identify issues that may impact reimbursement.
• Coordinate with PHC's credentialing team and payer credentialing departments throughout the enrollment process.

Data Management & Reporting

• Maintain accurate provider demographic and enrollment data within payer portals, and collaborate with Epic Systems Administrators (ESAs) to ensure provider information is added to Epic as needed.
• Maintain enrollment tracking logs and documentation.
• Assist with enrollment reporting and audits.
• Maintain complete and accurate enrollment documentation supporting all provider and facility records.

Credentialing & Provider Data Management

• Manage the CAQH Provider Data Portal, including re-attestation reminders and timely updates.
• Update the NPI registry (NPPES) for address, taxonomy, and demographic changes.
• Track expirables and follow up to ensure timely renewal of licenses, certifications, and other required documentation.
• Manage and verify taxonomy codes for accuracy across provider records.
• Process provider offboarding and payor disenrollment.

Process Improvement

• Identify and recommend workflow improvements that enhance enrollment accuracy and reduce processing delays.
• Participate in system enhancements, policy updates, and continuous improvement initiatives.

Performance Expectations

• Submit enrollment applications accurately and within established turnaround times.
• Maintain compliance with payer enrollment requirements.
• Minimize reimbursement delays caused by enrollment issues.
• Maintain accurate enrollment records and documentation.
• Provide responsive customer service to internal and external stakeholders.

Qualifications

Knowledge of healthcare provider enrollment, payer enrollment processes, Medicare, Medi-Cal, managed care plans, commercial insurance requirements, and regulatory compliance. Demonstrated organizational and analytical skills with the ability to manage multiple enrollment deadlines, interpret payer requirements, and communicate effectively with internal and external stakeholders.

Education & Experience

High school diploma or equivalent required. Provider enrollment, payer relations, credentialing support, or healthcare revenue cycle experience preferred. Federally Qualified Health Center (FQHC) and Epic/OCHIN experience preferred.

Desired Skills

• Knowledge of Medicare, Medi-Cal, managed care plans, and commercial payer enrollment processes.
• Experience with payer portals such as PECOS, PAVE, and CAQH, and enrollment applications.
• Strong organizational, project management, and attention to detail skills.
• Excellent written and verbal communication.
• Ability to manage multiple priorities while working independently and collaboratively.