Included Health
Healthcare
Sr.ProviderEnrollmentSpecialist
Neural analysis suggests this role is
optimal for Senior candidates.
“Sr. Provider Enrollment Specialist at Included Health. Skills: Provider enrollment, Credentialing, Payer relations. Manage provider enrollment and recredentialing. Execute provider enrollment and recredentialing”
What You'll Achieve.
Facilitate timely reimbursement; Ensure compliance; Improve enrollment timelines; Contribute to revenue integrity; Contribute to operational efficiency
Industry & Context.
Analyze enrollment data; Resolve complex payer issues; Resolve complex application issues
What They're Looking For.
Must Have
Associate's degree in Healthcare Administration, Business, or related field, 3-5 years of experience in provider enrollment, credentialing, or revenue cycle operations, Understanding of payer enrollment processes for commercial, Medicare, and Medicaid plans, Experience working with provider enrollment portals, Experience with electronic credentialing systems, Ability to analyze enrollment data, Resolve complex payer or application issues, Proficiency in Microsoft Office Suite, Experience with healthcare information systems
Nice to Have
Bachelor's degree preferred, Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM), Experience in a multi-specialty medical group or health system
What You'll Do.
Manage provider enrollment and recredentialing
Execute provider enrollment and recredentialing
Ensure accurate submission of enrollment applications
Ensure timely submission of enrollment applications
Monitor enrollment timelines
Follow up with payers
Maintain knowledge of payer enrollment requirements
Enter provider demographic information
Maintain provider credentialing information
Audit provider systems
Track license renewals
Manage CAQH attestation
Manage NPI registrations
Maintain understanding of billing system enrollment configurations
Maintain understanding of schedule system enrollment configurations
Resolve enrollment issues
Resolve enrollment rejections
Resolve lapses in network participation
Escalate complex issues
Maintain documentation of issues
Maintain communication of issues
Collaborate with billing teams
Collaborate with denial management teams
Resolve enrollment-related claim denials
Ensure compliance with federal guidelines
Ensure compliance with state guidelines
Ensure compliance with payer-specific guidelines
Maintain records of enrollment activities
Maintain records of correspondence
Maintain records of approval letters
Support internal reviews
Provide documentation for audits
Provide insight for audits
Partner with Revenue Cycle teams
Partner with Provider Relations teams
Partner with Credentialing teams
Provide subject matter expertise
Mentor junior team members
Contribute to process improvements
Enhance accuracy of provider onboarding
Enhance speed of provider onboarding
Enhance efficiency of provider onboarding
Enhance accuracy of provider enrollment
Enhance speed of provider enrollment
Enhance efficiency of provider enrollment
How You'll Work.
Team & Collaboration
Internal teams; Payer representatives; Provider relations teams; Revenue cycle teams; Billing teams; Denial management teams; Credentialing teams
Full Job Description
## Description The Sr. Provider Enrollment Specialist plays a critical role in ensuring healthcare providers are properly enrolled and credentialed with insurance payers, regulatory bodies, and internal systems to facilitate timely reimbursement and compliance. This position is responsible for overseeing the entire provider enrollment lifecycle—including initial credentialing, recredentialing, and demographic updates—while serving as a subject matter expert for internal teams. The Sr. Specialist will work collaboratively with payer representatives, provider relations, and revenue cycle teams to resolve complex enrollment issues and improve enrollment timelines, contributing to overall revenue integrity and operational efficiency. ## Provider Enrollment & Credentialing Manage and execute provider enrollment and recredentialing processes with commercial, Medicare, and Medicaid payers. Ensure accurate and timely submission of enrollment applications and supporting documentation. Monitor enrollment timelines, proactively following up with payers to avoid delays in reimbursement. Maintain current knowledge of payer enrollment requirements, regulations, and industry standards. ## Data Management & System Updates Accurately enter and maintain provider demographic and credentialing information in internal databases and payer portals. Audit provider files and systems regularly to ensure accuracy and compliance. Track and manage license renewals, CAQH attestation, NPI registrations, and other provider data elements required for successful enrollment. Maintain acute understanding of billing and schedule system enrollment configurations. ## Issue Resolution & Payer Communication Act as a liaison between payers, providers, and internal stakeholders to resolve enrollment issues, rejections, and lapses in network participation. Escalate complex issues appropriately while maintaining thorough documentation and communication. Collaborate with billing and denial management teams to r
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