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Provider Enrollment Specialist

  • TX, Irving

  • 03/20/2026

  • Contract

  • Active

Job Description:

  • Position Overview  
    We are seeking a detail-oriented and organized Provider Enrollment Specialist to manage the enrollment, credentialing, and maintenance of healthcare providers across multiple payer networks. This role ensures compliance with regulatory requirements, payer guidelines, and organizational standards while supporting providers through the enrollment lifecycle. The ideal candidate will have strong communication skills, knowledge of healthcare regulations, and experience with provider data management systems.

    Key Responsibilities
    1. Process provider enrollment applications for Medicare, Medicaid, and commercial insurance plans.
    2. Verify provider credentials, licenses, certifications, and compliance with regulatory standards.
    3. Maintain accurate provider records in enrollment and credentialing databases.
    4. Collaborate with providers, payers, and internal teams to resolve enrollment issues.
    5. Track application status and follow up with payers to ensure timely approvals.
    6. Assist providers with revalidation, recredentialing, and updates to enrollment information.
    7. Generate reports and maintain documentation for audits and compliance reviews.
    8. Ensure adherence to HIPAA, CMS, and payer-specific requirements.
    9. Support continuous improvement of enrollment processes and workflows.

    Required Skills & Qualifications
    1. 2–4 years of experience in provider enrollment, credentialing, or healthcare administration.
    2. Strong knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
    3. Familiarity with CAQH, PECOS, and other credentialing systems.
    4. Excellent organizational and time-management skills.
    5. Strong communication and customer service abilities.
    6. Proficiency with Microsoft Office Suite and data management tools.
    7. Ability to work independently and collaboratively in a fast-paced environment.

    Preferred Qualifications
    1. Experience with provider data management systems or credentialing software.
    2. Knowledge of healthcare compliance regulations and payer requirements.
    3. Prior experience in a hospital, clinic, or managed care organization.
    4. Certified Provider Credentialing Specialist (CPCS) or similar certification.

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