Provider Enrollment & Payer Compliance Coordinator

Health Partners is hiring a Provider Enrollment Coordinator. The Provider Enrollment Coordinator is responsible for managing all aspects of provider enrollment and revalidation with federal, state, and commercial payers to ensuretimelyandaccurateparticipation status. This role supports the onboarding lifecycle for physicians, advanced practice clinicians, and other healthcare providers by coordinating documentation,monitoring application progress, and communicating status updates to internal stakeholders and external agencies. Thecoordinatorensures compliance with organizational standards and payer-specific requirements, helping to prevent revenue disruption andoptimizeoperational efficiency.

MINIMUM QUALIFICATIONS:

• Education, Experience or Equivalent Combination:

• High school diploma or equivalent.

• 2+ years of experience in provider enrollment, medical staff services, credentialing, or revenue cycle operations.

• Knowledge, Skills, and Abilities:

  • Strong knowledge of Medicare/Medicaid enrollment processes and commercial payer requirements.

  • Excellent organizational skills and attention to detail.

  • Ability to manage multiple deadlines andshiftpriorities.

  • Strong communication skills and comfort interacting with providers and payer representatives.

PREFERRED QUALIFICATIONS:

• Education, Experience or Equivalent Combination:

  • Associate or bachelor’s degree in business, healthcare administration, orrelatedfield.

  • Experience with CAQH, PECOS, NPPES, and common credentialing/enrollment software systems.

ESSENTIAL DUTIES:

Provider Enrollment & Payer Management– 80%

• Enrollment consists of 10 entities and several outside contract entities.

• Prepare,submit, and track enrollment,forinitialenrollmentapplications forMN and WI Medicare,MN and WI Medicaid, andcontractualplans.
  
  Initial enrollment is basedon the contractualplanrequirement(profile, add/term/change form, spreadsheets, and portals).

• Prepare,submit revalidations forMN and WI Medicare,MN and WI Medicaid and commercialinsuranceplans.

• Reassign providers with Medicare Part A for our Critical Access Hospitals.

• Provider maintenanceincludingname changes, terms, and changeof practice locations.

• Monitor approval timelines and proactively resolve enrollment delays or discrepancies.

• Make updates to CAQH, PECOS, NPPES, and our contractual payer plans; databases.

• Re-attestation of provider data every
  120 daysto ensure data isaccuratefor the contractual plans.

• Enroll providers without-of-state
  
  Medicaid based on state specific requirements.

• Add assigned plans codes in EPIC once confirmation is received afterthe provider is enrolled.

Onboarding Support - 10%

• Collaborate closely with recruitment teams,credentialing, and Clinic Operations to ensure alignment of start dates and enrollment readiness.

• Assist providers with completing payer-required documentation and signatures.

• Serve as an enrollment subject matter expert for leadership, recruiters, and clinic teams.

• Deliver a positive, professional onboarding experience for providers

Data Integrity & Compliance– 10%

• Ensure all enrollment processes follow federal/state regulations, payer guidelines, and organizational policies.

• Maintainaccuratedigital records of applications, correspondence, approvals, and effective dates.

• Support audits, quality reviews, and process improvement initiatives.

* Job description rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.