Job Summary
The Payor Enrollment Specialist will be responsible for managing the end-to-end provider enrollment
process with commercial insurance payors, Medicare, Medicaid, and other government health plans.
The ideal candidate will ensure timely and accurate submission of enrollment applications, maintain
provider records, and collaborate with internal teams to support successful provider onboarding and
uninterrupted reimbursement.
Key Responsibilities
- Complete and submit provider enrollment, revalidation, and re-enrollment applications with
commercial and government payors.
- Manage provider enrollment through various payer portals and applications.
- Maintain and update provider information in CAQH and other enrollment databases.
- Track enrollment applications and follow up with insurance companies to ensure timely
processing.
- Coordinate with credentialing, licensing, and operations teams to obtain required
documentation.
- Resolve enrollment-related issues by communicating with payors and internal stakeholders.
- Maintain accurate records of application status, approvals, expirations, and renewals.
- Ensure compliance with payer guidelines, regulatory requirements, and organizational
policies.
- Prepare enrollment status reports and maintain proper documentation.
- Assist with provider onboarding and offboarding activities related to payor enrollment.
Required Qualifications
- Bachelor's degree in any discipline.
- 1–3 years of experience in US Healthcare Payor Enrollment, Provider Enrollment,
Credentialing, or a related healthcare operations role.
- Strong understanding of Medicare, Medicaid, and commercial payor enrollment processes.
- Experience working with CAQH, NPPES, PECOS, and insurance payer portals is preferred.
- Excellent written and verbal communication skills.
