Enrollment Specialist (Payer Enrollment & Credentialing)

Position Summary:

We are seeking an experienced Enrollment Specialist to manage payer enrollment activities across multiple lines of business, including Medicaid (Georgia), Medicare, Tricare, and Molina. This role is responsible for end-to-end provider enrollment, revalidation, and maintenance, ensuring timely and accurate submissions while maintaining compliance with payer and regulatory requirements. The ideal candidate is a self-starter who can work independently, navigate payer portals efficiently, and manage a high-volume workload with minimal supervision.

Key Responsibilities:

• Manage full-cycle provider enrollment and revalidation processes for Medicaid (Georgia), Medicare, Tricare, and Molina
• Prepare, submit, and track enrollment applications through various payer portals and systems
• Maintain accurate and up-to-date provider records in internal databases and payer systems
• Monitor application status, follow up with payers, and resolve enrollment issues or delays proactively
• Ensure compliance with all federal, state, and payer-specific requirements and timelines
• Collaborate with internal teams (credentialing, operations, contracting) to ensure alignment and timely onboarding
• Identify process gaps and recommend workflow improvements to enhance efficiency and turnaround times
• Maintain detailed documentation and reporting on enrollment status and key metrics
• Stay current on payer requirements, portal updates, and regulatory changes 

Qualifications:

• Minimum of 5 years of experience in provider enrollment
• Hands-on experience with Medicaid (Georgia), Medicare, Tricare, and Molina enrollment processes
• Strong working knowledge of payer portals and enrollment platforms (e.g., PECOS, state Medicaid portals, Tricare, etc.)
• Proven ability to manage multiple enrollments across locations and providers simultaneously
• Experience working in a high-volume, deadline-driven environment
• High level of accuracy and attention to detail 

Skills & Competencies:

• Self-motivated with the ability to work independently and prioritize workload effectively
• Strong problem-solving skills and ability to navigate complex enrollment issues
• Excellent organizational and time management skills
• Clear and professional communication skills, both written and verbal
• Ability to adapt to changing processes and evolving payer requirements
• Proficiency in Microsoft Office and enrollment/credentialing systems 

Preferred Qualifications:

• Experience supporting multi-state or multi-site healthcare organizations
• Experience with credentialing databases (e.g., MD-Staff, CAQH, or similar systems) 

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