Enrollment Specialist

• 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.

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