Position Summary
The Provider Enrollment Manager is responsible for overseeing the enrollment and credentialing of healthcare providers with government and commercial insurance payers. This role ensures providers are properly enrolled, credentialed, and maintained in payer systems to support accurate billing and reimbursement.
Key Responsibilities
- Manage the provider enrollment process for physicians and healthcare providers with Medicare, Blue Cross, Medicaid, and commercial insurance payers.
- Oversee initial enrollments, revalidations, updates, and terminations for provider participation with insurance networks.
- Ensure accurate and timely submission of provider applications and supporting documentation.
- Monitor enrollment status and follow up with payers to resolve delays or issues.
- Maintain provider information in systems such as CAQH, PECOS, and payer portals.
- Ensure compliance with payer regulations, credentialing standards, and organizational policies.
- Maintain accurate provider records, licenses, certifications, and credentialing documentation.
- Collaborate with billing, contracting, credentialing, and administrative teams to ensure providers are properly set up for claims submission.
- Track enrollment metrics and provide reports to leadership.
- Identify process improvements to increase efficiency and reduce enrollment delays.
Qualifications
- Experience in provider enrollment, credentialing, or healthcare administration.
- Strong knowledge of Medicare, Blue Cross, Medicaid, and commercial payer enrollment processes.
- Experience with systems such as CAQH, PECOS, NPPES, and payer portals.
- Excellent organizational and communication skills.
- Ability to manage multiple enrollments and deadlines simultaneously.
- Attention to detail and strong problem-solving skills.
Preferred Skills
- Experience in medical billing or revenue cycle management.
- Leadership or management experience.
- Knowledge of provider contracting and payer requirements.