Provider Enrollment Specialist
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Job Description
Provider Enrollment Specialist managing enrollments of healthcare providers for Upstream Rehabilitation. Collaborating with teams to ensure compliance and accuracy in enrollment processes.
Responsibilities:
- Manage provider and facility enrollment with health plans and payors, ensuring compliance with contractual, regulatory, and accrediting requirements
- Collaborate with credentialing, recruitment, and sales teams to support a consistent and accurate weekly enrollment process
- Prepare and submit provider enrollment reports, respond to payer inquiries and validations, and proactively resolve discrepancies
- Maintain accurate enrollment records to ensure precise reporting for providers, clients, and credentialed therapists
- Review and maintain provider enrollment data and directories, ensuring policies, workflows, and reporting timelines are met
- Support resolution of enrollment‑related contract and claims issues with payors and providers
- Create clear, engaging training materials and support dissemination of enrollment information as needed
- Conduct periodic file reviews to evaluate accuracy, timeliness, and data quality, identifying opportunities to improve performance and efficiency
- Identify and recommend process improvements and automation opportunities to increase accuracy and scalability
- Adhere to HIPAA guidelines and all applicable privacy and security regulations
- Other projects and duties as assigned.
Requirements:
- High school diploma or GED.
- Experience working in provider enrollment or a closely related healthcare operations function.
- Strong attention to detail with a focus on accuracy and compliance.
- Excellent customer service, written, verbal, and presentation skills.
- Highly organized with the ability to manage multiple priorities and deadlines.
- Comfortable navigating multiple software systems and screens simultaneously.
- Proficient with virtual collaboration tools such as Microsoft Teams or Zoom.
Benefits:
- 100% employer paid medical health insurance premium option available
- Dental and Vision insurance
- 401(k) with company match
- Generous PTO and paid holidays
- Supportive team and leadership invested in your success
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