Provider Enrollment Specialist

Socket.dev; Franklin (TN); On-site; USD 42,000 - 65,000; Full time

Job summary

EnableComp is hiring a Provider Enrollment Specialist, Medicaid, to oversee and maintain the professional and facility enrollment process. You will submit online and paper applications and handle PHI with strict privacy and security.

The role requires developing state-specific enrollment policies, maintaining up-to-date knowledge of Medicaid rules, and coordinating with leadership to ensure timely submissions and compliance.

Qualifications

• High School Diploma or GED required; further degree preferred.
• 1+ years’ experience in healthcare billing or collections.
• 1+ years’ client facing/customer service experience.
• Understanding of payer/provider claims processing and data needs.
• Knowledge of enrollment requirements and documents for applications.

Responsibilities

• Collect, verify, and submit information for enrollment of hospitals/physicians with Out-of-State Medicaid payers.
• Develop and maintain enrollment policies and procedures by state.
• Maintain knowledge of Medicaid enrollment requirements; educate internal team members.
• Submit re-enrollment applications timely to keep enrollment active.
• Ensure compliance with government rules for Out-of-State Medicaid.
• Manage work queue for payor-specific forms and documents to health plans.
• Maintain provider file updates and communicate changes in the database.

Skills

Healthcare billing

Customer service

Claims processing

MS Office proficiency

Education

High School Diploma or GED

Associates or Bachelor's degree preferred

Tools

Microsoft Office

Job description

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterativeintelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

Position Summary

The Provider Enrollment Specialist, Medicaid, has primary responsibility for oversight and maintenance of the professional and facility enrollment process. This will include submission of both online and paper applications. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

Key Responsibilities

• Collect, verify, and submit information necessary for the enrollment of hospitals/physicians with Out-of-State Medicaid payers.
• Develop and maintain ongoing policy and procedures specific to each state for new hospital/physician enrollments.
• Maintain working knowledge of hospital/physician Out-of-State Medicaid enrollment requirements and regulations. Ensure appropriate education and communication is shared with internal team members, including the Vice President and Senior Vice President of Operations.
• Submits re-enrollment applications in a timely manner to ensure hospitals/physicians are up to date with their enrollment status.
• Establish, maintain, and constantly review the accuracy of Out-of-State Medicaid requirements to ensure compliance with government rules and regulations.
• Manage work queue to ensure all timely submissions/deadlines of all payor-specific forms and documents to the various health plans including license updates, deficiency notifications, approval letters, etc.
• All maintenance of the provider file and communication of provider changes, corrections, and terminations documented in the database.

Requirements and Qualifications

• High School Diploma or GED required. Associates or Bachelor’s Degree preferred.
• 1+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Thorough understanding of the enrollment requirements and documents needed for the accurate completion of applications
• Knowledge of general credentials and licenses is preferred but not required: hospital license, CLIA, DEA, NPI, board certifications, etc.
• Equivalent combination of education and experience will be considered.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Regular and predictable attendance.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites

• Practices and adheres to EnableComp’s Core Values, Vision and Mission.
• Proven ability to meet and/or exceed productivity targets and goals.
• Maintains stable performance under pressure or opposition. Handles stress in ways to maintain relationships with all stakeholders.
• Must be a self-starter and able to work independently without direct supervision.
• Proven written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Proven experience working with external clients; strong customer service skills and business acumen.
• Ability to prioritize and manage multiple competing priorities and projects concurrently.
• Must be able to remain in stationary position 50% of the time.
• Occasionally moves about inside the office to access office equipment, etc.
• Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone and computer.

EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.

EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you.

Don’t just take our word for it! Hear what our people are saying:

“I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” – Revenue Specialist

“I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” – Supervisor, Operations