Provider Enrollment Specialist — Payer & CMS Focus

Ventra Health, Inc.; Clark, Northern (NJ, KY); Hybrid; USD 55,000 - 70,000; Full time

Benefits offered by this job

Performance-based incentive plan

Referral bonus

Job summary

Ventra Health, Inc. is seeking a Provider Enrollment Specialist to work with the Provider Enrollment Manager to identify payer enrollment issues, resolve denials, and enroll CMS Medicare, Medicaid, and other payers using CMS portals and client systems.

You will contact clients, operations, and CMS by phone, email, or online, maintain enrollments, track revalidation dates, and ensure provider numbers are linked to the correct client group. Strong communication and confidentiality are essential.

Qualifications

• Associate's degree required; Bachelor's degree in any related field preferred.
• At least 1 year of provider enrollment experience preferred.
• Knowledge of CMS, State Medicaid, and third-party payer enrollment processes.

Responsibilities

• Research, resolve, and enroll payer issues for provider enrollments.
• Follow up with CMS and other payers via phone, email, or website.
• Manage CMS Medicare, State Medicaid, and other payer applications.
• Track and ensure provider numbers are linked to the correct client group and systems.
• Maintain enrollment documentation and reporting.
• Maintain provider demographics in enrollment systems.
• Add providers to enrollment systems and ensure claims are processed based on enrollment status.
• Participate in special projects as assigned.

Skills

Oral communication

Written communication

Interpersonal skills

Detail orientation

Analytical thinking

Decision making

Problem solving

Organizational skills

Time management

Independent work

Confidentiality

Team collaboration

Education

Associate's degree

Bachelor's degree preferred

Tools

Word processing

Spreadsheets

Database software

Presentation software

Job description

Ventra Health, Inc. is seeking a Provider Enrollment Specialist to work with the Provider Enrollment Manager to identify payer enrollment issues, resolve denials, and enroll CMS Medicare, Medicaid, and other payers using CMS portals and client systems.

You will contact clients, operations, and CMS by phone, email, or online, maintain enrollments, track revalidation dates, and ensure provider numbers are linked to the correct client group. Strong communication and confidentiality are essential.