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Provider Enrollment Specialist

Posted an hour ago
0-2 years experience
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AI Summary

The Provider Enrollment Specialist manages payer enrollment activities by preparing and submitting applications to Medicare, Medicaid, and commercial insurance plans. They are responsible for tracking enrollment status, resolving discrepancies, and maintaining accurate provider records in internal systems.

Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. As a Provider Enrollment Specialist, you will manage payer enrollment activities for provider clients, helping ensure providers and practices are properly enrolled with Medicare, Medicaid, and commercial insurance plans. You will prepare applications, track enrollment status, resolve issues, and maintain accurate payer and provider information.

WHAT YOU WILL DO

  • Prepare and submit provider enrollment applications to Medicare, Medicaid, and commercial payers

  • Gather and review provider information and supporting documentation required for enrollment

  • Track enrollment applications, payer requests, approvals, and effective dates

  • Follow up with payers and enrollment organizations on pending or delayed applications

  • Research and resolve enrollment discrepancies, rejections, and missing information

  • Maintain accurate provider and payer enrollment records in internal systems and online portals

  • Process updates to provider information, including practice locations, specialties, and affiliations

  • Coordinate enrollment-related information with credentialing, billing, and client teams

  • Monitor enrollment deadlines and support timely revalidation, renewals, and payer updates

WHAT WE ARE LOOKING FOR

  • 1+ year of experience in provider enrollment, payer enrollment, credentialing, medical billing, or a related healthcare administrative role

  • Understanding of Medicare, Medicaid, and commercial payer enrollment processes

  • Experience preparing and submitting enrollment applications and supporting documentation

  • Familiarity with payer portals and online provider enrollment systems

  • Strong attention to detail and ability to manage multiple applications and deadlines

  • Strong organizational and follow-up skills

  • Ability to research enrollment issues and communicate effectively with payers and provider teams

  • Ability to work independently and effectively in a fully remote environment

  • HIPAA-compliant private workspace

NICE TO HAVE

  • Experience with CAQH

  • Knowledge of NPI, taxonomy codes, PECOS, and other provider enrollment requirements

  • Experience with Medicare and Medicaid revalidation

  • Experience working with multiple commercial payers

  • Experience with hospital or multi-specialty provider enrollment

  • Familiarity with Epic, Athena, eClinicalWorks, or other healthcare systems

COMPENSATION AND BENEFITS

Compensation will be discussed during the interview and will reflect the candidate’s experience, qualifications, and relevant healthcare administration expertise.

Benefits and additional employment details will be discussed during the hiring process.

HIRING PROCESS

Application review → introductory conversation → hiring manager interview → offer.

EQUAL OPPORTUNITY

Raventra Health is an equal opportunity employer. We consider all qualified applicants without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic. If you need an accommodation at any stage of the hiring process, please contact us and we will work with you to provide appropriate support.

Location: Remote

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