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Sr. Provider Enrollment Specialist

2 weeks, 2 days ago
United States
Full-time
Senior
Operations Specialist
Operations
Apply Now
Included Health

Included Health

Included Health is a healthcare company that provides cost-saving solutions for employers and health plans. They offer virtual care and navigation services, connecting millions with board-certified doctors and specialists for comprehensive and convenie...

Insurance
1K-5K
$106M raised
View All Jobs 27

Description

  • Manage the full provider enrollment and recredentialing lifecycle for commercial, Medicare, and Medicaid payers.
  • Submit accurate enrollment applications and supporting documentation in a timely manner.
  • Monitor enrollment timelines and follow up with payers to prevent reimbursement delays.
  • Maintain provider demographic, credentialing, license, CAQH, NPI, and related enrollment data in internal systems and payer portals.
  • Audit provider files and system records for accuracy, compliance, and enrollment readiness.
  • Serve as a liaison among payers, providers, and internal stakeholders to resolve enrollment rejections, lapses, and other complex issues.
  • Collaborate with billing and denial management teams to resolve enrollment-related claim denials.
  • Maintain detailed documentation of enrollment activities, correspondence, approval letters, and audit support records.
  • Partner with Revenue Cycle, Provider Relations, and Credentialing teams to align enrollment work with organizational needs.
  • Provide subject matter expertise, mentorship, and process improvement support to junior team members.

Requirements

  • Associate’s degree in Healthcare Administration, Business, or a related field required; Bachelor’s preferred.
  • 3-5 years of experience in provider enrollment, credentialing, or revenue cycle operations.
  • Strong understanding of payer enrollment processes for commercial, Medicare, and Medicaid plans.
  • Experience using provider enrollment portals such as PECOS, CAQH, and Availity.
  • Experience with electronic credentialing systems.
  • Ability to analyze enrollment data and resolve complex payer or application issues.
  • Proficiency in Microsoft Office Suite.
  • Experience with healthcare information systems, including EHR and practice management systems.
  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
  • Experience in a multi-specialty medical group or health system preferred.

Benefits

  • Base salary range of $60,500 to $79,200 per year.
  • Remote-first culture.
  • 401(k) savings plan through Fidelity.
  • Comprehensive medical, vision, and dental coverage, including disability insurance options.
  • Paid Time Off (PTO) and Discretionary Time Off (DTO).
  • 12 weeks of 100% paid parental leave.
  • Family-building and compassionate leave, including fertility coverage and up to $25,000 for surrogacy/adoption.
  • Work-from-home reimbursement to support home office collaboration.

Interested in this position?

Apply directly on the company website

Apply Now

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