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.