Enrollment Specialist

UCSF Health

. Coordinate and monitor initial and ongoing provider enrollment applications with commercial health plans, Medicare, Medi-Cal, and other applicable payers.

Posted 10/7/2026full-timeRemote • California • United StatesJuniorMid-Level💰 $33 - $37 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in provider enrollment and credentialing processes, ensuring compliance with healthcare regulations and maintaining accurate provider information across various systems. Proficient in tracking enrollment applications and collaborating with stakeholders to resolve discrepancies and improve processes.

Highest-signal resume keywords

Provider EnrollmentCredentialing ProcessesPayer PortalsHealthcare ComplianceMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider EnrollmentCredentialingHealthcare AdministrationPayer OperationsAudit DocumentationProvider Database ManagementEnrollment TrackingData ValidationProcess ImprovementRegulatory Compliance

Soft Skills

CollaborationCommunicationProblem-SolvingAttention to DetailConfidentiality

Tools & Technologies

CAQHPECOSNPPESPayer PortalsMicrosoft ExcelMicrosoft WordMicrosoft Outlook

Industry Keywords

Healthcare AdministrationProvider CredentialingPayer RequirementsHICE AuditsEnrollment Trends

About the role

Key responsibilities & impact

Coordinate and monitor initial and ongoing provider enrollment applications with commercial health plans, Medicare, Medi-Cal, and other applicable payers.
Track enrollment applications from submission through completion and maintain accurate status documentation.
Conduct follow-up with health plans and payer representatives regarding pending applications, missing information, processing delays, and enrollment determinations.
Identify enrollment issues and discrepancies and collaborate with internal departments and payer representatives to resolve them.
Monitor requests for additional documentation and ensure required information is obtained and submitted timely.
Maintain enrollment tracking systems, databases, spreadsheets, and payer records.
Escalate delayed, denied, or problematic enrollments to leadership.
Assist with provider demographic and practice location updates across payer systems.
Support provider credentialing and recredentialing activities.
Maintain provider affiliations, specialties, addresses, tax identification information, NPI information, and other payer-required data.
Ensure accurate provider information in CAQH, PECOS, NPPES, payer portals, and other systems.
Review provider information and identify discrepancies between internal records and payer databases.
Assist with provider roster reconciliation and coordinate corrections.
Support credentialing and enrollment-related projects.
Assist with HICE audits and other compliance reviews.
Gather, organize, validate, and maintain enrollment and credentialing documentation for audits.
Review provider files for missing, incomplete, or inconsistent information.
Track audit action items and support completion of documentation requests.
Maintain records for audit readiness and regulatory compliance.
Maintain accurate, complete, and confidential provider enrollment records.
Document enrollment activities and payer communications.
Prepare enrollment reports and status updates.
Identify recurring payer issues, enrollment trends, and process improvement opportunities.
Adhere to organizational policies, payer requirements, and regulatory standards.
Collaborate with Credentialing, Contracting, Billing, Operations, and other stakeholders.

Requirements

What you’ll need

High school diploma or equivalent required.
Associate's degree or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
Two (2) or more years of experience in provider enrollment, credentialing, healthcare administration, medical group operations, payer operations, or a related healthcare environment preferred.
Experience working with commercial and/or government health plans preferred.
Experience using payer portals and provider databases preferred.
Proficiency with Microsoft Office applications, including Excel, Word, and Outlook.
Knowledge of provider enrollment and payer participation processes.
Knowledge of commercial and government payer requirements.
Knowledge of CAQH, PECOS, NPPES, payer portals, and provider roster management.
Knowledge of provider credentialing and recredentialing processes.
Knowledge of healthcare compliance requirements and audit documentation practices.
Knowledge of HICE audit standards and processes.
Knowledge of provider demographic, affiliation, TIN, and NPI maintenance.
Ability to protect confidential provider, patient, organizational, and business information.