Provider Enrollment & Credentialing Specialist

EmergencyMD; Town of Ithaca (NY); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Centralus Health is seeking a Provider Enrollment Specialist to manage provider enrollment data and applications across the Cayuga Health Partners network. The role ensures compliance with internal policies, health-plan rules, and regulatory guidelines, serving as a liaison between CHP providers, practices, and payers.

The ideal candidate has an Associate's degree and 2–5 years in provider enrollment or credentialing, with strong attention to detail and communication skills.

Qualifications

• Associate's degree required.
• 2–5 years of experience in provider enrollment or credentialing with IPA/Medical Group/Hospital experience or healthcare operations experience (claims processing, billing, provider relations or contracting).
• Notary Public certification preferred (optional).

Responsibilities

• Perform provider enrollment activities as necessary.
• Manage completing and submitting provider enrollment applications for CHP providers according to plan specifications.
• Review enrollment documents for completeness (licensure, liability insurance, DEA, etc.).
• Follow up with physicians/providers on missing information to complete enrollment.
• Generate, mail, track, and process provider revalidation applications; liaise with health plans to resolve delays.
• Update Provider Data Management System with new information.
• Work with health plans to maintain their Provider Rosters.
• Notify health plan and CHP participants on contract termination dates and membership re-assignments.
• Maintain an accurate Provider Roster and communicate changes to CHP staff.
• Maintain extensive knowledge of provider enrollment; take on other responsibilities as needed.

Education

Associate's degree

Job description

Centralus Health is seeking a Provider Enrollment Specialist to manage provider enrollment data and applications across the Cayuga Health Partners network. The role ensures compliance with internal policies, health-plan rules, and regulatory guidelines, serving as a liaison between CHP providers, practices, and payers.

The ideal candidate has an Associate's degree and 2–5 years in provider enrollment or credentialing, with strong attention to detail and communication skills.