CrawlJobs Logo

Provider Enrollment Specialist

mmcgrp.com Logo

MMC Group LP

Location Icon

Location:
United States , Austin

Category Icon
Category:
Customer Service

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

Not provided
Save Job
Save Icon
Apply Position

Job Description:

The Provider Enrollment Specialist supports Medicaid provider enrollment and file maintenance activities by interacting professionally with healthcare providers and ancillary staff. This role ensures accurate, timely processing of enrollment applications and maintenance requests while meeting daily productivity and quality standards. This is a production-driven, detail-oriented role that requires strong communication skills, independent decision-making, and the ability to work effectively in a fast-paced, compliance-focused environment.

Job Responsibility:

  • Process 100 percent of assigned provider enrollment applications and maintenance requests to completion using documented work instructions
  • Meet or exceed minimum daily production targets
  • Identify deficiencies and notify providers of incomplete or inaccurate applications
  • Revise deficiencies and submit corrections based on Quality Assurance audit findings
  • Respond to provider inquiries regarding application status
  • Research and contact providers by phone to resolve enrollment application issues as needed
  • Adhere to Quality Assurance standards to maintain required minimum quality scores
  • Maintain strict confidentiality of provider information and files in compliance with HIPAA requirements
  • Make recommendations to management to improve efficiency and effectiveness of enrollment processes
  • Flexibility to work overtime based on daily production inventory requirements
  • Perform additional duties as assigned by leadership

Requirements:

  • Minimum of 6 months of recent experience enrolling and credentialing healthcare providers
  • At least 1 year of professional experience in customer service, data entry, or a related role
  • Mid-to-high level computer proficiency, including Microsoft Office applications
  • Excellent verbal and written communication skills
  • Strong attention to detail with a quality-focused mindset
  • Ability to work independently while following direction and meeting deadlines

Nice to have:

  • Recent hands-on experience with healthcare provider enrollment and credentialing
  • Strong critical thinking skills to analyze enrollment applications and resolve issues
  • Self-motivated, organized, and accountable for assigned workloads
  • Ability to adapt to changing priorities and procedures in a fast-moving environment
  • Willingness to learn multiple enrollment types and commit to ongoing skill development
What we offer:
  • Medical, dental, and vision coverage
  • Life and disability insurance
  • Additional voluntary benefits

Additional Information:

Job Posted:
February 17, 2026

Employment Type:
Fulltime
Work Type:
On-site work
Icon
MMC Group LP - All Job Offers
Job Link Share:
Copy Link Icon
Facebook Icon Twitter Icon LinkedIn Icon

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Provider Enrollment Specialist

Provider Enrollment Specialist II - HP Enrollment Eligibility

Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care cred...
Location
Location
United States , Irving
Salary
Salary:
Not provided
christushealth.org Logo
CHRISTUS Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High School Diploma
  • 1-3 years of Payer Enrollment experience
  • Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS
  • Excellent written and verbal communication skills
  • Excellent organization and planning skills with demonstrated teamwork skills
  • Proven ability to interact with all levels of management and other Associates
Job Responsibility
Job Responsibility
  • Collects and maintains data on providers for Medicare and Medicaid enrollment
  • Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates
  • follows up by telephone or in writing, with carriers regarding application status
  • Complies with Medicare and Medicaid provider enrollment guidelines
  • Requests NPI numbers for providers and clinics as necessary and maintains NPI files
  • Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals
  • Generates various reports to identify outstanding claims issues with provider numbers and non-payment
  • Communicates information to appropriate personnel
  • Educates staff on corrections, e.g.. front-end entry errors in a positive, constructive manner
  • Collects and reviews managed care contracts for correct billing and payment terms
  • Fulltime
Read More
Arrow Right

Outbound Enrollment Specialist

As an Outbound Enrollment Representative, you will be responsible for making out...
Location
Location
United States
Salary
Salary:
40000.00 - 50000.00 USD / Year
pomelocare.com Logo
Pomelo Care
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Ability to work Monday-Friday, 8:30am - 5:00pm CT
  • Strong, empathetic communication skills
  • Motivated by goals, metrics, and monthly bonus program
  • Passionate about changing the current landscape of healthcare
  • Strong organizational and time-management skills
  • Ability to work independently and as part of a team
  • Willing to work occasional overtime hours
  • Are internet-connected, able to work remotely
Job Responsibility
Job Responsibility
  • Conduct high volume outbound calls to patients to provide information and education about Pomelo Care services and resources
  • Achieve member enrollment goals as driven by company KPIs
  • Support patients by answering their questions, addressing their concerns, and providing guidance on how Pomelo can support their needs
  • Document all interactions and maintain timely, accurate records of patient outreach activities
  • Collaborate internally and externally with healthcare providers, community organizations, and other stakeholders to ensure patients receive appropriate care and services
  • Work with families to schedule appointments and follow-up care as needed
  • Participate in training and development opportunities to stay current on healthcare trends and regulations
  • Manage inbound calls from potential patients
What we offer
What we offer
  • Competitive healthcare benefits
  • Generous vacation policy
  • Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)
  • Uncapped performance bonus paid out monthly
  • Fulltime
Read More
Arrow Right

Bilingual Outbound Enrollment Specialist

As an Outbound Enrollment Representative, you will be responsible for making out...
Location
Location
United States
Salary
Salary:
45000.00 - 55000.00 USD / Year
pomelocare.com Logo
Pomelo Care
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Ability to work Monday-Friday, 8:30am - 5:00pm CT
  • Fluent in Spanish and English
  • Strong, empathetic communication skills
  • Motivated by goals, metrics, and monthly bonus program
  • Passionate about changing the current landscape of healthcare
  • Strong organizational and time-management skills
  • Ability to work independently and as part of a team
  • Willing to work occasional overtime hours
  • Are internet-connected, able to work remotely
Job Responsibility
Job Responsibility
  • Conduct high volume outbound calls to patients to provide information and education about Pomelo Care services and resources
  • Achieve member enrollment goals as driven by company KPIs
  • Support patients by answering their questions, addressing their concerns, and providing guidance on how Pomelo can support their needs
  • Document all interactions and maintain timely, accurate records of patient outreach activities
  • Collaborate internally and externally with healthcare providers, community organizations, and other stakeholders to ensure patients receive appropriate care and services
  • Work with families to schedule appointments and follow-up care as needed
  • Participate in training and development opportunities to stay current on healthcare trends and regulations
  • Manage inbound calls from potential patients
What we offer
What we offer
  • Competitive healthcare benefits
  • Generous vacation policy
  • Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)
  • Uncapped performance bonus paid out monthly
  • Fulltime
Read More
Arrow Right

Provider Credentialing Specialist

Work with the New Ventures team to complete health plan credentialing accurately...
Location
Location
United States
Salary
Salary:
55000.00 - 75000.00 USD / Year
pomelocare.com Logo
Pomelo Care
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2-4 years of experience in a high volume, credentialing specialist role
  • Deep expertise with commercial health plan credentialing processes, including health plan portals & CAQH
  • Highly organized with a strong attention to detail
  • A proactive and resourceful problem-solver who is comfortable navigating ambiguity and independently seeks out answers and solutions
  • An accountable and collaborative team player with excellent communication skills, both written and verbal
  • An expert at prioritization & time management, who proactively shares deliverable timelines and roadblocks
Job Responsibility
Job Responsibility
  • Complete group & practitioner health plan credentialing on behalf of Pomelo’s telehealth clinic & care team
  • Track applications from submission to approval, contracting, and agreement, ensuring cross-functional visibility into key milestones & timelines
  • Proactively mitigate application delays & denials
  • Rigorously follow up on any delays and/or denials to right-size
  • Collaborate with Pomelo licensing, credentialing, and enrollment team to ensure proper clinician licensure & up-to-date CAQH profiles, to help expedite health plan credentialing
  • Collaborates with care team of nurses, nurse practitioners, doctors, therapists & registered dietitians to support navigation & answer questions about clinician credentialing applications
What we offer
What we offer
  • Competitive healthcare benefits
  • Generous equity compensation
  • Unlimited vacation
  • Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)
Read More
Arrow Right

Provider Enrollment Specialist

The Provider Enrollment Specialist ensures seamless plan enrollment (initial and...
Location
Location
United States , St. Louis
Salary
Salary:
21.00 - 27.00 USD / Hour
anderscpa.com Logo
Anders Minkler Huber & Helm LLP
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate degree, preferred
  • High School diploma or GED required
  • 3-5 years of experience in payer enrollment
  • Strong organizational and time management skills, with the ability to manage multiple tasks and meet deadlines
  • Excellent attention to detail and accuracy in data entry and record-keeping
  • Effective communication skills, both written and verbal, with the ability to interact professionally with providers, staff and external entities
  • Ability to work independently and as part of a team, demonstrating flexibility and adaptability
  • Strong problem-solving skills, with the ability to identify and resolve issues promptly and effectively
  • Knowledge of healthcare regulations and compliance requirements
  • Familiarity with NCQA, URAC, and CMS standards
Job Responsibility
Job Responsibility
  • Process and submit initial provider applications, revalidations, and renewal applications in compliance with NCQA, URAC, and CMS accreditation standards
  • Perform thorough and accurate data entry and verification of provider information into credentialing databases
  • Conduct timely follow-up on missing or incomplete information with the provider, client, or team lead responsible for a provider file to ensure prompt and efficient provider enrollment
  • Assist in the preparation and submission of required documentation for provider enrollment and credentialing to include delegation rosters
  • Coordinate with internal staff and external entities to resolve issues related to provider enrollment and credentialing
  • Monitor and track the status of provider applications, payer directories, conducting regular follow-up with health plans until verification of completion is received from each payor
  • Support the enrollment and delegation team with various tasks as needed
What we offer
What we offer
  • Work Flex program which gives you the opportunity to work at our Chesterfield office, our Downtown St. Louis office, remotely, adopt a hybrid approach or even switch between these options as you prefer
  • Professional development opportunities
  • Benefits that directly impact mental, physical and financial wellness
  • Fulltime
Read More
Arrow Right

Credentialing Enrollment Specialist

Location
Location
United States , Charlotte
Salary
Salary:
24.10 - 36.15 USD / Hour
advocatehealth.com Logo
Advocate Health Care
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High school diploma or GED required
  • Bachelor's degree preferred
  • Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment
  • Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone
  • Experience in typing, word processing, and business correspondence
  • Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred
Job Responsibility
Job Responsibility
  • Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers
  • Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office
  • Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants
  • Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner
  • Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities
  • Conducts practice site visits for practices within MGD
  • Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System
  • Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System's demographics and participation
  • Provides Team member support to the CPN Credentialing and Quality Review Committee
What we offer
What we offer
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program
  • Fulltime
Read More
Arrow Right
New

Provider Enrollment Specialist

Our client is seeking a detail-oriented Provider Enrollment Analyst for a fully ...
Location
Location
United States , Royal Oak
Salary
Salary:
30.00 - 35.00 USD / Hour
medasource.com Logo
Medasource
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2–3 years of hands-on experience with Medicare provider enrollment (CMS-855 applications) or Medicare Administrative Contractor (MAC) processes
  • Strong understanding of government payer enrollment timelines, compliance, and documentation standards
  • Advanced Excel skills including V-lookups, data manipulation, filtering, and validation
  • Proficiency in Microsoft Word, SharePoint, and PDF document management
  • Excellent written and verbal communication skills with the ability to collaborate effectively across teams
  • Highly organized, detail-oriented, and capable of managing multiple concurrent priorities in a complex environment
  • Self-motivated and proactive
  • takes initiative without waiting for direction
  • Collaborative team player thriving in cross-functional environments
  • Demonstrates natural leadership and healthy conflict-resolution skills
Job Responsibility
Job Responsibility
  • Prepare, complete, and update CMS-855A, 855B, 855S, and MDPP Medicare enrollment applications and associated documentation in compliance with CMS timelines (30–90 days)
  • Maintain detailed filing systems for drafts, feedback, approvals, and supplemental paperwork across a large portfolio of hospitals and provider entities
  • Track and manage CLIA (Clinical Laboratory Improvement Amendments) and license documentation, ensuring accuracy and regulatory compliance
  • Conduct preliminary data validation, flagging inconsistencies such as address mismatches, expired credentials, or missing information
  • Retrieve legal files and manage the secure exchange of protected information (PII) between departments
  • Maintain and update a robust SharePoint site for documentation, tracking, and team communication
  • Create and manage Excel tracking spreadsheets for enrollments, license expirations, and revalidation schedules
  • Ensure all documentation adheres to standardized naming and filing conventions for audit readiness
  • Support preparation and documentation for quarterly education meetings, including agendas and reports
  • Participate in daily huddles and team training sessions to align on workflow, priorities, and process updates
What we offer
What we offer
  • Flexible remote work environment
  • Opportunity to support a large health system and gain exposure to complex government payer enrollment processes
  • Collaborative, team-oriented culture focused on communication and process improvement
  • Potential for contract extension based on performance and business needs
  • Professional growth and development opportunities
  • Competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage
  • 401k plan with company match
  • Paid time off, sick time, and paid company holidays
  • Employee Assistance Program (EAP) providing services like virtual counseling, financial services, legal services, life coaching
  • Fulltime
Read More
Arrow Right

Client Partner – Credentialing Specialist

Join our team in Manila as a Client Partner - Credentialing Specialist. We are s...
Location
Location
Philippines , Taguig City
Salary
Salary:
Not provided
accesshealthcare.com Logo
Access Healthcare LLC
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Strong knowledge of Payer Processes and Credentialing
  • Willingness to work continuously in night shifts
  • Must be fluent in English language
  • Willing to work in the night shift at our office in McKinley Hill, Taguig
  • Must have at least 1 year of experience in Credentialing processes for US healthcare customers
Job Responsibility
Job Responsibility
  • Manage the end-to-end provider enrollment process, ensuring healthcare providers are properly credentialed and enrolled with insurance networks
  • Conduct thorough review of provider documentation, ensuring compliance with credentialing requirements and proactively resolving any discrepancies
  • Serve as a liaison between healthcare providers and insurance companies, addressing enrollment-related inquiries and facilitating timely resolution
  • Maintain accurate and up-to-date provider information in databases, and collaborate with internal teams to streamline the enrollment and billing processes
Read More
Arrow Right
Jobs by Category
Art and Entertainment Jobs Banking Jobs Call Center Jobs Construction Jobs Consulting Jobs Customer Service Jobs Education Jobs Energy Jobs Finance Jobs Gastronomy Jobs Health and Beauty Jobs Hospitality and Tourism Jobs Human Resources Jobs Insurance Jobs IT - Administration Jobs IT - Software Development Jobs Legal Jobs Logistics Jobs Manufacturing Jobs Marketing, Digital Marketing, SEO, SEM Jobs Media Jobs Nursing Jobs Office Administration Jobs Pharmacy Jobs Physical Work Jobs Public Relations Jobs Public Sector Jobs Purchasing Jobs Quality Control Jobs Real Estate Jobs Research and Development Jobs Sales Jobs
Job Positions Jobs by Country
United States Jobs United Kingdom Jobs India Jobs Canada Jobs Australia Jobs Germany Jobs Ireland Jobs Poland Jobs
Company
Blog About Us Contact
Follow Us
Facebook
X (Twitter)
LinkedIn
Instagram
CrawlJobs Group
ITFlashcards AllDevBlogs
© 2026 CrawlJobs Ltd. All Rights Reserved
Terms & Conditions Privacy Policy