Provider Enrollment Specialist

Job Description

Job DescriptionDescription

NANI is seeking a dedicated and detail-oriented Provider Enrollment Specialist to join our Credentialing Department. This role is responsible for all aspects of payer enrollment, including managing and submitting applications to Medicare, Medicaid, and commercial insurance payers, ensuring timely and accurate enrollment and revalidation for all NANI providers and facilities. The ideal candidate will bring a strong background in payer enrollment and a thorough understanding of credentialing processes.

The scope of this position includes enrollment and recredentialing/revalidation of individual clinicians, submission of delegated payer rosters, and enrollment of Ambulatory Surgery Centers (ASCs) and dialysis centers in accordance with payer and regulatory requirements.

Responsibilities

• Manage end-to-end payer enrollment processes for new and existing providers, including Medicare, Medicaid, and commercial payers.
• Complete and submit provider applications, contracts, and required documentation for payer enrollment and revalidation.
• Submit and maintain delegated payer rosters accurately and within required timeframes.
• Oversee and complete the enrollment of ASCs and dialysis centers with all applicable payers.
• Track application status and proactively follow up to ensure timely processing and approvals.
• Maintain up-to-date records of payer participation and enrollment status in credentialing databases and systems.
• Monitor and respond to recredentialing and revalidation requirements to avoid disruptions in provider or facility billing.
• Collaborate with internal departments such as Human Resources, Revenue Cycle, and Compliance to gather and verify required information.
• Stay informed on changes to payer enrollment policies, guidelines, and regulations.
• Serve as a liaison between NANI and insurance payers, addressing enrollment issues and inquiries promptly.
• Provide audit support and generate status reports on provider and facility enrollment as needed.
• Maintain strict confidentiality of provider and organizational information.

Minimum Qualifications

• Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or a related field.
• Minimum 2 years of direct experience in payer enrollment, with emphasis on Medicare, Medicaid, and commercial payers.
• Experience in facility enrollment, including ASCs and dialysis centers, is strongly preferred.
• Understanding of delegated credentialing processes and delegated roster submission requirements.
• Proficient in credentialing/enrollment systems and payer portals.

Preferred Qualifications

• Certification from a recognized credentialing organization (e.g., NAMSS CPCS or CPMSM).
• Hands-on experience with CAQH ProView, PECOS, NPPES, and payer-specific enrollment systems.
• Prior experience in nephrology, dialysis services, or multi-specialty healthcare environments.

Skills & Competencies

• Strong attention to detail and organizational abilities.
• Capacity to manage multiple projects and deadlines simultaneously.
• Excellent verbal and written communication skills.
• Independent problem-solving skills and initiative.
• High degree of professionalism and discretion in handling sensitive data.