Provider Enrollment Coordinator

• Facilitate enrollment through payer applications for provider groups and individual providers
• Maintain CAQH profiles, reporting, and provider attestations every 120 days
• Prepare applications for new providers across multiple contract sites, payers, and states
• Submit applications electronically to payers based on contracts
• Track applications and follow up to ensure timely completion and payer approval
• Communicate with clinicians, state payers, insurance carriers, third-party billing companies, and internal staff
• Build relationships with payers to facilitate enrollment and obtain provider billing numbers
• Prepare correspondence and submit provider and group application information to payers
• Work with in-house and third-party billing companies on applications, system updates, and problem resolution
• Handle corrections or claim rejections caused by enrollment errors or claim submission requirements
• Communicate issues and problem status to the Enrollment Manager
• Submit held A/R enrollments promptly and maintain held A/R reports to maximize income opportunities
• Meet or exceed enrollment performance standards and time-sensitive deadlines
• Update application status in system databases and Excel reports
• Determine applications requiring management approval or special processing
• Manage high-volume enrollments and drive provider enrollments through completion
• Assist with enrollment reporting for Superior Health, Healthscope, Cigna, and other payers
• Maintain Enrollment Master Reports and track submissions, re-validations, and re-enrollments for providers and groups
• Adhere to company policies and procedures

• High School Diploma
• 2+ years payer enrollment (individual provider and group enrollment) or related experience
• Ability to obtain, set-up, maintain, and reattest CAQH profiles
• Prior government healthcare payer experience
• Excellent analytical, organizational, and verbal/written communication skills
• Strong telephone skills
• Ability to manage multiple priorities with high attention to detail in a high-volume, fast-paced environment
• Strong customer service orientation
• Ability to use discretion appropriately and maintain confidentiality
• High proficiency with Microsoft Office applications, especially Microsoft Word and Excel
• Ability to read, write, and speak English proficiently
• Preferred:
  Bachelor’s degree
• Preferred:
  Enrollment experience with both Commercial and Government Plans
• Preferred:
  Multi-state Enrollment Experience
• Ability to fulfill office activities, including computer-based work and filing
• Occasionally lift and/or move up to 20–25 pounds

Demonstrates expertise in payer enrollment processes, including CAQH profile management and application submissions across multiple states and payers. Strong analytical and organizational skills are essential for managing high-volume enrollments and ensuring compliance with deadlines.

• Payer Enrollment Experience
• CAQH Profile Management
• Microsoft Office Proficiency
• Analytical Skills
• Customer Service Orientation

• Payer Enrollment
• CAQH Profile Maintenance
• Application Submission
• Enrollment Reporting
• Data Tracking
• Claim Resolution
• Multi-state Enrollment
• Government Healthcare Experience
• High Attention to Detail
• Enrollment Performance Standards

• Verbal Communication
• Written Communication
• Organizational Skills
• Telephone Skills
• Discretion and Confidentiality

• Healthcare Payer
• Provider Enrollment
• Insurance Carriers
• Third-party Billing
• Enrollment Master Reports

• Microsoft Word
• Microsoft Excel
• System Databases