Enrollment & Credentialing Specialist

Petaluma Health Center Inc; Petaluma (CA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Paid Time Off

Holidays

Medical Insurance

Dental Insurance

Vision Insurance

401K Matching

Flexible Spending Account

Life Insurance

Long Term Disability

Employee Assistance Program

Job summary

Petaluma Health Center Inc is seeking an Enrollment Specialist to maintain provider and facility enrollments, support revalidations, and ensure regulatory compliance across payer networks.

You will work with providers, Human Resources, Revenue Cycle, Finance, and a credentialing team to keep enrollment records accurate, up-to-date, and ready for reimbursement, while delivering responsive service to internal and external stakeholders.

Qualifications

• Knowledge of Medicare, Medi-Cal, managed care plans and commercial payer enrollment requirements.
• Demonstrated organizational and analytical skills to manage multiple enrollment deadlines and communicate with stakeholders.
• Experience with payer portals such as PECOS, PAVE, and CAQH.

Responsibilities

• Prepare, submit, and track provider and facility enrollment applications.
• Coordinate initial enrollments, revalidations, reactivations, changes of information, and terminations.
• Maintain enrollment records, supporting documentation, and required signatures.
• Monitor application status and follow up with payer organizations until completion.
• Research and resolve enrollment issues to prevent delays.
• Collaborate with Human Resources, provider leadership, Revenue Cycle, Finance, and the credentialing team.

Skills

Attention to detail

Communication skills

Project management

Independent and collaborative work

Education

High school diploma or equivalent

Provider enrollment/credentialing/revenue cycle experience

Epic/OCHIN experience preferred

Tools

CAQH Provider Data Portal

PECOS

PAVE

NPPES

Epic/OCHIN

Job description

Petaluma Health Center Inc is seeking an Enrollment Specialist to maintain provider and facility enrollments, support revalidations, and ensure regulatory compliance across payer networks.

You will work with providers, Human Resources, Revenue Cycle, Finance, and a credentialing team to keep enrollment records accurate, up-to-date, and ready for reimbursement, while delivering responsive service to internal and external stakeholders.