Provider Enrollment Specialist

Company Overview

National Partners in Healthcare (NPH) is a progressive healthcare company specializing in anesthesiology. We partner with physicians and health systems to deliver high quality care, aligning synergies and best practices to achieve superior outcomes. As a leader in the industry, we believe in developing a foundation of trust, transparency, and excellence in everything we do. The success of our company has created excellent career advancement opportunities that support a healthy work/life balance.

Position Summary:

The Provider Enrollment Specialist is responsible for managing the enrollment and revalidation of healthcare providers with government and commercial payers. This role ensures accurate and timely submission of enrollment applications, maintenance of provider records, and compliance with payer, regulatory, and organizational requirements. The Specialist serves as a key liaison between providers, payers, and internal departments to resolve enrollment issues, prevent claim delays, and support uninterrupted reimbursement. Strong attention to detail, knowledge of payer guidelines, and effective communication skills are essential to success in this role.

Essential Duties and Responsibilities:

• Prepare, submit, and track provider enrollment, revalidation, and recredentialing applications with government and commercial payers (e.g., Medicare, Medicaid, commercial insurance plans).
• Maintain current and accurate provider demographic, licensure, certification, and contract information in enrollment systems, credentialing databases, and payer portals.
• Serve as the primary point of contact for providers regarding enrollment status, documentation requirements, timelines, and payer correspondence.
• Review enrollment applications for completeness, accuracy, and compliance with payer and regulatory requirements prior to submission.
• Communicate regularly with payer representatives to resolve application discrepancies, follow up on pending submissions, and address denials or terminations.
• Coordinate with internal departments such as credentialing, billing, compliance, and contracting to ensure alignment of provider data and minimize claim rejections.
• Monitor enrollment statuses and proactively identify and resolve issues that could delay provider activation or disrupt reimbursement.
• Maintain thorough documentation of enrollment activities, correspondence, and approvals in accordance with organizational policies and audit standards.
• Ensure timely revalidation and recredentialing to prevent lapses in payer participation.
• Stay current on payer enrollment guidelines, CMS regulations, and industry best practices to ensure ongoing compliance.
• This position has daily, ongoing contact with administrative staff, clinical providers and other outside contacts. This position has no direct reports.
• All other duties as assigned.

KNOWLEDGE, SKILLS, ABILITIES

Excellent computer, data entry and clerical skills, knowledge of business office procedures required. Must possess excellent interpersonal, clerical, telephone and communication skills. The ability to multi-task, deal effectively with a variety of situations requiring judgment and poise is necessary. Attention to detail and organizational abilities are essential. Demonstrated working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred. Two plus years of experience in payer credentialing required.

EDUCATION & EXPERIENCE

Associate's degree in Business Administration(BA) or related field, or equivalent combination of education and experience required. Two years of credentialing experience required. A minimum of two-five years' experience and proven proficiency in provider enrollment payer credentialing required.

At NPH, we believe in accountability, collaboration, and continuous improvement. We value team members who take ownership, communicate openly, and are always looking for better ways to serve our clients and each other.

Core Values

Driver for Results - Our goal is not only to meet expectations but to consistently exceed them. We anticipate and take action to exceed customer needs, and we define and evaluate quality standards.

Continuous Improvement- We seek opportunities to improve our services, streamline our work processes and make our customers more satisfied. We generate ideas that go beyond the status quo and recognize the need for new or modified approaches. We act as a catalyst for change.

Teamwork - We have a commitment to common goals based on open and honest communication while showing concern, support and respect for each other. We embrace everyone's unique talents and honor diverse life and work styles. We operate in a spirit of cooperation and value human dignity. To be successful, NPH must be a rewarding place to work. We provide opportunity and encouragement to help our people reach their potential.

Customer Service - At NPH colleagues, patients, shareholders and providers are all important customers. We recognize that our customers are the reason for our success, and we are committed to listening to and responding positively to their needs and concerns.

Integrity - We strive to do what is right and do what we say we will do. We earn the trust of others through consistency of actions and transparency with stated values and commitments. We take responsibility for our actions and have a strong personal sense of what is right and wrong.

Please note that quoted salary ranges are not guarantees of what final salary offers may be. Base pay is based on market location and will vary depending on job-related knowledge, skills, and experience. Base pay is only one part of the Total Rewards that NPH provides to compensate and recognize our staff for their work. Full-time positions are eligible for a discretionary bonus and a comprehensive benefits package.