Provider Enrollment & Payer Compliance Coordinator

HealthPartners; BLOOMINGTON (MN); Sur place; USD 60 000 - 90 000; Plein temps

Résumé du poste

HealthPartners in Minnesota seeks a Provider Enrollment Coordinator to manage enrollment and revalidation with federal, state, and commercial payers. The role supports onboarding for physicians and clinicians, coordinating documentation, monitoring progress, and communicating status to internal teams and external agencies.

The ideal candidate has experience in provider enrollment or credentialing, strong organization, and excellent communication skills to navigate payer requirements and ensure

Qualifications

• Experience in provider enrollment, credentialing, or revenue cycle operations.
• Knowledge of Medicare/Medicaid enrollment processes.
• Experience with CAQH, PECOS, NPPES preferred.
• Strong communication and attention to detail.

Responsabilités

• Manage enrollment for MN and WI Medicare and Medicaid and commercial plans.
• Prepare, submit, and track initial enrollments and revalidations.
• Reassign providers with Medicare Part A for CA hospitals.
• Maintain provider records and monitor approval timelines.
• Assist onboarding and coordinate with recruitment and clinic teams.
• Ensure compliance with federal/state regulations and payer guidelines.
• Support audits and process improvements.

Connaissances

Medicare/Medicaid enrollment knowledge

Organizational skills

Deadline & priority management

Provider & payer communication

Formation

High school diploma or equivalent

Associate or Bachelor's degree in business / healthcare administration

Outils

CAQH

PECOS

NPPES

Enrollment software systems

Description du poste

HealthPartners is hiring a Provider Enrollment Coordinator. The Provider Enrollment Coordinatoris responsible formanaging all aspects of provider enrollment and revalidation with federal, state, and commercial payers to ensuretimelyandaccurateparticipation status. This role supports the onboarding lifecycle for physicians, advanced practice clinicians, and other healthcare providers by coordinating documentation,monitoringapplication progress, and communicating status updates to internal stakeholders and external agencies. Thecoordinatorensures compliance with organizational standards and payer-specific requirements, helping to prevent revenue disruption andoptimizeoperational efficiency.

MINIMUM QUALIFICATIONS:

• Education, Experience or Equivalent Combination:

• High school diploma or equivalent.

• 2+ years of experience in provider enrollment, medical staff services, credentialing, or revenue cycle operations.

• Knowledge, Skills, and Abilities:

  • Strong knowledge of Medicare/Medicaid enrollment processes and commercial payer requirements.

  • Excellent organizational skills and attention to detail.

  • Ability to manage multiple deadlines andshiftpriorities.

  • Strong communicationskills and comfort interacting with providers and payer representatives.

PREFERRED QUALIFICATIONS:

• Education, Experience or Equivalent Combination:

  • Associate or bachelor’s degree in business, healthcare administration, orrelatedfield.

  • Experience with CAQH, PECOS, NPPES, and common credentialing/enrollment software systems.

ESSENTIAL DUTIES:

Provider Enrollment & Payer Management– 80%

• Enrollment consists of 10 entities and several outside contract entities.

• Prepare,submit, and track enrollment,forinitialenrollmentapplications forMN and WIMedicare,MN and WIMedicaid, andcontractualplans.Initial enrollment is basedon the contractualplanrequirement(profile, add/term/change form, spreadsheets, and portals).

• Prepare,submitrevalidations forMN and WIMedicare,MN and WIMedicaid and commercialinsuranceplans.

• Reassignproviders with Medicare Part A for our Critical Access Hospitals.

• Provider maintenanceincludingname changes, terms, and changeof practice locations.

• Monitor approval timelines and proactively resolve enrollment delays or discrepancies.

• Makeupdates to CAQH, PECOS, NPPES, and our contractual payer plans; databases.

• Re-attestation of provider data every120 daysto ensuredata isaccuratefor the contractual plans.

• Enroll providers without-of-stateMedicaid based on state specific requirements.

• Add assigned plans codes in EPIC once confirmation isreceived afterthe provider is enrolled.

Onboarding Support - 10%

• Collaborate closely withrecruitment teams,credentialing, andClinic Operations to ensure alignment of start dates and enrollment readiness.

• Assistproviders with completing payer-required documentation and signatures.

• Serve as an enrollment subject matter expert for leadership, recruiters, and clinic teams.

• Deliver a positive, professional onboarding experience for providers

Data Integrity & Compliance– 10%

• Ensure all enrollment processes follow federal/state regulations, payer guidelines, and organizational policies.

• Maintainaccuratedigital records of applications, correspondence, approvals, and effective dates.

• Support audits, quality reviews, and process improvement initiatives.

*Job description rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.