Senior Provider Enrollment Specialist (Remote)

Northern Light Health; Brewer (ME); Remote; USD 30,720 - 47,141; Full time

Job summary

Northern Light Health is seeking a Provider Enrollment Specialist III to manage provider and facility enrollment and re-credentialing for NLH contracted payers. The role partners with revenue cycle and clinical leadership to resolve enrollment barriers and monitor held claims for timely actions.

The ideal candidate will be a certified enrollment specialist with knowledge of CAQH Proview, PECOS, Availity, and payer portals, and will lead or support complex enrollment initiatives while adhering to

Qualifications

• CPES or PESC certification required.
• Advanced knowledge of Medicare, PECOS, NPPES, CAQH and provider data management.
• Experience resolving complex enrollment issues, payer denials, and enrollment gaps.

Responsibilities

• Assist enrollment and re-credentialing applications per payer requirements.
• Collaborate with credentialing staff and hospital leadership for documentation.
• Serve as subject matter expert for governmental payers.
• Update provider IDs and enrollment dates to ensure timely claims.
• Resolve enrollment rejections, delays, and follow up on denied claims.

Skills

Enrollment

Payer enrollment

CAQH Proview

PECOS

Availity

MIMHS

Payer portals

Documentation

Regulatory compliance

Education

Bachelor's degree

Tools

CAQH Proview

PECOS

Availity

MIMHS

Job description

Northern Light Health is seeking a Provider Enrollment Specialist III to manage provider and facility enrollment and re-credentialing for NLH contracted payers. The role partners with revenue cycle and clinical leadership to resolve enrollment barriers and monitor held claims for timely actions.

The ideal candidate will be a certified enrollment specialist with knowledge of CAQH Proview, PECOS, Availity, and payer portals, and will lead or support complex enrollment initiatives while adhering to