Enrollment Specialist; Remote

Summary: The Enrollment Specialist supports accurate and timely provider enrollment through the preparation, validation, submission, and tracking of provider rosters to payors. This role runs and analyzes roster reports, reconciles provider and practice data, resolves submission discrepancies, and works closely with practice credentialing contacts, payors, and internal stakeholders to obtain required information and communicate enrollment status. The Enrollment Specialist maintains organized, accurate, and audit-ready enrollment records in accordance with payor requirements, internal policies, and applicable regulatory guidelines.

Essential Duties and Responsibilities:

• Prepare, validate, and submit initial, recurring, and ad hoc provider rosters to payors in accordance with established schedules, file formats, and submission requirements.
• Run roster and enrollment reports to monitor provider additions, changes, terminations, effective dates, outstanding items, and submission outcomes.
• Review roster data for completeness and accuracy, including provider identifiers, demographics, practice locations, specialties, tax information, and participation details.
• Reconcile internal provider records against payor rosters, reports, portals, and response files; research and correct discrepancies promptly.
• Partner with practice credentialing contacts to collect missing information, validate provider changes, confirm submission readiness, and communicate required follow-up.
• Track roster submissions, payor acknowledgments, rejections, pend items, and effective dates through completion, escalating aging or high-impact issues as appropriate.
• Process provider additions, demographic changes, location updates, tax identification changes, terminations, and other enrollment maintenance transactions.
• Maintain accurate provider enrollment data, submission logs, correspondence, and supporting documentation in designated databases, shared files, and payor portals.
• Generate routine and ad hoc reports for leadership and operational partners, highlighting submission volume, completion status, exceptions, aging, and data-quality trends.
• Communicate clearly and professionally with practice credentialing contacts, payors, vendors, and internal departments regarding roster requirements, status, missing information, and issue resolution.
• Follow established standard operating procedures, payor-specific requirements, quality controls, and submission calendars.
• Support process improvements, root-cause review of recurring roster errors, special projects, and system enhancement initiatives as assigned.
• Maintain confidentiality of provider, organizational, and sensitive business information.

Measurable Goals/Objectives:

• Maintain 98% or greater accuracy for roster data, submission files, enrollment records, and reports.
• Complete scheduled roster submissions and assigned enrollment transactions by established internal and payor deadlines.
• Reconcile submission results and payor rosters within established turnaround times, documenting and resolving identified discrepancies.
• Provide timely, accurate status updates and follow-up to practice credentialing contacts and internal stakeholders on open enrollment items.

Supervisory Responsibilities: None.

Competencies: To perform the job successfully, an individual should demonstrate the following competencies:

• Strong attention to detail, accuracy, data quality, and follow-through.
• Working knowledge of provider enrollment, payor roster processes, provider demographics, and healthcare data requirements.
• Ability to organize and prioritize recurring submissions, report schedules, deadlines, and stakeholder requests in a fast-paced environment.
• Ability to analyze roster reports, reconcile data from multiple sources, identify trends, and resolve discrepancies.
• Professional communication and relationship-management skills with practice credentialing contacts, payors, vendors, and internal departments.
• Ability to maintain confidentiality and handle sensitive information appropriately.
• Proficiency with Microsoft Excel and other Office applications, enrollment databases, payor portals, reporting tools, and electronic file management systems.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the…