Sr. Provider Enrollment Specialist

The Sr. Provider Enrollment Specialist plays a critical role in ensuring healthcare providers are properly enrolled and credentialed with insurance payers, regulatory bodies, and internal systems to facilitate timely reimbursement and compliance. This position is responsible for overseeing the entire provider enrollment lifecycle—including initial credentialing, recredentialing, and demographic updates—while serving as a subject matter expert for internal teams. The Sr. Specialist will work collaboratively with payer representatives, provider relations, and revenue cycle teams to resolve complex enrollment issues and improve enrollment timelines, contributing to overall revenue integrity and operational efficiency. Pay: The base salary range for this full-time position is $60,500  – $79,200 per year in the United States. This posted range reflects the portion of our internal salary band that is currently funded for new hires in this role across our standard labor markets (Zones A–C). For context, these markets include Zone A (e.g., Phoenix AZ, San Antonio TX, Columbus OH, Charlotte NC), Zone B (e.g., Chicago IL, Denver CO, San Diego CA, Houston TX), and Zone C (e.g., Los Angeles CA, Seattle WA, Washington, D.C., Boston MA). At this time, we are not budgeting for hires in higher-cost Zone D markets (e.g., San Francisco Bay Area CA, New York City NY, San Jose CA) for this role. Within this range, individual pay is determined by work location, skills, experience, and internal equity. We use structured salary bands and geographic zones based on cost of labor to keep pay fair and consistent. Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry. Benefits & Perks: In addition to receiving a great compensation package, the compensation package may include, depending on the role, the following and more: Remote-first culture 401(k) savings plan through Fidelity Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance) Paid Time Off ("PTO") and Discretionary Time Off (“DTO") 12 weeks of 100% Paid Parental leave Family Building & Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies. Work-From-Home reimbursement to support team collaboration home office work Your recruiter will share more about the salary range and benefits package for your role during the hiring process. About Included Health Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com. ----- Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law. Provider Enrollment & Credentialing: Manage and execute provider enrollment and recredentialing processes with commercial, Medicare, and Medicaid payers. Ensure accurate and timely submission of enrollment applications and supporting documentation. Monitor enrollment timelines, proactively following up with payers to avoid delays in reimbursement. Maintain current knowledge of payer enrollment requirements, regulations, and industry standards. Data Management & System Updates: Accurately enter and maintain provider demographic and credentialing information in internal databases and payer portals. Audit provider files and systems regularly to ensure accuracy and compliance. Track and manage license renewals, CAQH attestation, NPI registrations, and other provider data elements required for successful enrollment. Maintain acute understanding of billing and schedule system enrollment configurations. Issue Resolution & Payer Communication: Act as a liaison between payers, providers, and internal stakeholders to resolve enrollment issues, rejections, and lapses in network participation. Escalate complex issues appropriately while maintaining thorough documentation and communication. Collaborate with billing and denial management teams to resolve enrollment-related claim denials. Compliance & Documentation: Ensure compliance with all federal, state, and payer-specific guidelines related to provider enrollment. Maintain detailed and organized records of all enrollment activities, correspondence, and approval letters. Support audits and internal reviews by providing documentation and insight into provider status. Collaboration & Cross-Functional Support: Partner with Revenue Cycle, Provider Relations, and Credentialing teams to align enrollment efforts with organizational needs. Provide subject matter expertise and mentorship to junior team members regarding enrollment best practices and processes. Contribute to ongoing process improvements to enhance the accuracy, speed, and efficiency of provider onboarding and enrollment. Required Qualifications: Associate’s degree in Healthcare Administration, Business, or related field required (Bachelor’s preferred). Minimum of 3-5 years of experience in provider enrollment, credentialing, or revenue cycle operations. Strong understanding of payer enrollment processes for commercial, Medicare, and Medicaid plans. Experience working with provider enrollment portals (e.g., PECOS, CAQH, Availity) and electronic credentialing systems. Ability to analyze enrollment data and resolve complex payer or application issues effectively. Proficiency in Microsoft Office Suite and experience with healthcare information systems (EHR, practice management systems). Preferred Qualifications: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM). Experience in a multi-specialty medical group or health system.

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    {
      "text": "Provider Enrollment & Credentialing:",
      "content": "\n<li>Manage and execute provider enrollment and recredentialing processes with commercial, Medicare, and Medicaid payers.</li>\n<li>Ensure accurate and timely submission of enrollment applications and supporting documentation.</li>\n<li>Monitor enrollment timelines, proactively following up with payers to avoid delays in reimbursement.</li>\n<li>Maintain current knowledge of payer enrollment requirements, regulations, and industry standards.</li>\n"
    },
    {
      "text": "Data Management & System Updates:",
      "content": "\n<li>Accurately enter and maintain provider demographic and credentialing information in internal databases and payer portals.</li>\n<li>Audit provider files and systems regularly to ensure accuracy and compliance.</li>\n<li>Track and manage license renewals, CAQH attestation, NPI registrations, and other provider data elements required for successful enrollment.</li>\n<li>Maintain acute understanding of billing and schedule system enrollment configurations.</li>\n"
    },
    {
      "text": "Issue Resolution & Payer Communication:",
      "content": "\n<li>Act as a liaison between payers, providers, and internal stakeholders to resolve enrollment issues, rejections, and lapses in network participation.</li>\n<li>Escalate complex issues appropriately while maintaining thorough documentation and communication.</li>\n<li>Collaborate with billing and denial management teams to resolve enrollment-related claim denials.</li>\n"
    },
    {
      "text": "Compliance & Documentation:",
      "content": "\n<li>Ensure compliance with all federal, state, and payer-specific guidelines related to provider enrollment.</li>\n<li>Maintain detailed and organized records of all enrollment activities, correspondence, and approval letters.</li>\n<li>Support audits and internal reviews by providing documentation and insight into provider status.</li>\n"
    },
    {
      "text": "Collaboration & Cross-Functional Support:",
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    },
    {
      "text": "Required Qualifications:",
      "content": "<div>\n\n<li>Associate’s degree in Healthcare Administration, Business, or related field required (Bachelor’s preferred).</li>\n<li>Minimum of 3-5 years of experience in provider enrollment, credentialing, or revenue cycle operations.</li>\n<li>Strong understanding of payer enrollment processes for commercial, Medicare, and Medicaid plans.</li>\n<li>Experience working with provider enrollment portals (e.g., PECOS, CAQH, Availity) and electronic credentialing systems.</li>\n<li>Ability to analyze enrollment data and resolve complex payer or application issues effectively.</li>\n<li>Proficiency in Microsoft Office Suite and experience with healthcare information systems (EHR, practice management systems).<br>&nbsp;</li>\n\n</div>"
    },
    {
      "text": "Preferred Qualifications:",
      "content": "\n<li>Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).</li>\n<li>Experience in a multi-specialty medical group or health system.</li>\n"
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