Credentialing Enrollment Specialist

Job Summary

The Credentialing Enrollment Specialist is responsible for obtaining and maintaining provider participation with contracted health plans by managing initial payer enrollments, revalidations, and enrollment-related updates. This role prepares, submits, and tracks provider enrollment applications, coordinates with payers to resolve enrollment issues, and ensures providers are enrolled and eligible to bill for services. The Credentialing Enrollment Specialist partners closely with the Credentialing Coordinator and Credentialing Maintenance Specialist to support a seamless provider lifecycle and uninterrupted reimbursement.

Essential Duties and Responsibilities

1. Prepare, submit, and track provider enrollment applications with commercial, Medicaid, TRICARE, and other contracted health plans. 
2. Coordinate provider revalidations, reenrollments, and other ongoing payer participation requirements to maintain active network status. 
3. Monitor enrollment application status and proactively follow up with payer representatives to resolve delays and outstanding requests. 
4. Collaborate with Human Resources, Clinical Operations, Revenue Cycle, and Compliance to ensure providers are enrolled prior to rendering services whenever possible. 
5. Maintain organized documentation of enrollment applications, approvals, correspondence, and payer confirmations. 
6. Research payer-specific enrollment requirements and communicate changes that may impact provider participation. 
7. Respond to internal inquiries regarding enrollment status and provider network participation. 
8. Assist with onboarding new clinic locations, provider additions, and organizational expansion initiatives requiring payer enrollment. 
9. Identify opportunities to improve enrollment workflows and contribute to process documentation and standard operating procedures.
10. Manage payer enrollment timelines to support provider start dates and organizational growth initiatives.
11. Resolve enrollment-related issues, including application deficiencies, rejected enrollments, and payer requests for additional documentation.
12. Coordinate with the Credentialing Maintenance Specialist when approved providers require ongoing demographic or maintenance updates after enrollment is complete.

Qualifications:

• Exceptional organizational skills with strong attention to detail and a commitment to accuracy. 
• Ability to manage multiple provider enrollment, credentialing, and recredentialing applications while meeting established deadlines. 
• Strong prioritization and time management skills, with the ability to balance competing priorities in a fast-paced environment. 
• Knowledge of provider enrollment, credentialing, and recredentialing requirements across multiple payers and states. 
• Proficient in Microsoft Office Suite, CAQH, payer portals, and credentialing/enrollment database systems. 
• Experience preparing, submitting, tracking, and following up on provider enrollment and credentialing applications. 
• Strong verbal and written communication skills, with the ability to effectively interact with providers, payers, and internal stakeholders. 
• Ability to interpret and apply payer, regulatory, and accreditation requirements related to provider enrollment and credentialing. 
• Thorough understanding of confidentiality requirements and the ability to handle sensitive provider and organizational information with discretion. 
• Ability to work independently while collaborating effectively with Credentialing, Revenue Cycle, Compliance, Human Resources, and Clinical Operations teams.

Education/Experience Requirements

• High school diploma or equivalent required
• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred. 
• Minimum of two (2) years of experience in provider enrollment, credentialing, healthcare administration, or a related healthcare support role. 
• Experience preparing, submitting, and tracking provider enrollment and credentialing applications with Medicaid, government and commercial payers.

Physical Requirements

While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time. The team member is occasionally required to stand, walk, and use hands to operate a computer keyboard. The team member may occasionally lift and or move up to 25 pounds. Vision requirements include close vision, distance vision, depth perception and the ability to adjust focus.

Company Overview: 

Lighthouse Autism Center is the leading Applied Behavior Analysis (ABA) therapy provider in Indiana, Iowa, North Carolina, Nebraska, Michigan, and Illinois and expanding within those states and other states across the U.S. Since 2012, Lighthouse Autism Center has provided the highest quality, center-based ABA therapy to children with autism. At Lighthouse, children work on things like social skills, daily living skills, communication skills, and school-readiness skills. All children are overseen by Board Certified Behavior Analysts and programs are implemented by Registered Behavior Technicians. Lighthouse Autism Center also has full-time Speech-Language Pathologists on staff who provide co-treat and consultative services speech therapy services to children who attend the centers.