Sr. Provider Enrollment Specialist

Henry-Ford-Health-2; Bingham Farms (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

Henry Ford Health in Detroit seeks a Provider Enrollment Specialist to manage the full enrollment lifecycle for qualified practitioners across government programs and commercial plans. You will guide applications from submission to directory inclusion and continuous updates, ensuring accuracy and compliance.

You will document health plan activities, verify required materials, and serve as a liaison between payers, clinics, and providers while upholding privacy standards and performance targets.

Qualifications

• High school diploma required; associate degree preferred.
• 2-5 years of provider enrollment, provider billing or credentialing experience required.
• Ability to work in a fast-paced environment with deadlines and multitasking.
• Excellent verbal and written communication skills.
• Proficient in data entry, documentation, and adherence to payer standards.

Responsibilities

• Drive the provider enrollment process from application receipt through directory inclusion, managing initial enrollment, re-credentialing, and revalidation.
• Execute comprehensive data entry to maintain enrollment database integrity.
• Verify required documentation and materials to ensure compliant submissions.
• Issue welcome, denial, or termination letters and communicate clearly with stakeholders.
• Document health plan activities and maintain an audit-ready record.

Skills

Data entry

Analytical skills

Communication

Multitasking

Education

High School Diploma

Associate’s Degree preferred

Tools

EPIC

Morrisey

Webdenis

CHAMPS

PECOS

CAQH

Microsoft Office

Job description

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus.

Job Description

GENERAL SUMMARY:

As a Provider Enrollment Specialist, you'll play a vital role in our organization's success by managing the complete provider enrollment lifecycle. Working under general supervision, you'll ensure that qualified practitioners are seamlessly enrolled in government programs and commercial health plans, from initial application through directory inclusion and ongoing updates. This position combines data management expertise with relationship-building skills, requiring proficiency in data entry, collection, and analysis while maintaining strict compliance with payer standards and regulations.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Drive the provider enrollment process from application receipt through directory inclusion, managing initial enrollment, re-credentialing, and revalidation with precision and efficiency
• Execute comprehensive and accurate data entry to maintain enrollment database integrity, ensuring all provider information is current and compliant
• Verify all required documentation and information, securing necessary materials to ensure providers are processed according to current policies and procedures
• Issue welcome, denial, or termination letters as appropriate, maintaining clear communication throughout the enrollment journey

Systems & Process Excellence:

• Demonstrate in-depth working knowledge of key payor applications including Webdenis, CHAMPS, PECOS, and CAQH, leveraging these tools to streamline workflow processes
• Execute the Network Management workflow in real time, consistently meeting required turnaround times and accuracy benchmarks
• Document all health plan activities, communications, and follow-up attempts according to department standards, creating a comprehensive audit trail
• Participate actively in system integration and continuous quality improvement initiatives to enhance departmental efficiency

Relationship & Problem-Solving:

• Serve as the primary liaison between payers, clinics, and providers, building strong relationships and ensuring timely, accurate management of participation status
• Research and resolve denied claims and enrollment issues, demonstrating strong analytical and problem-solving capabilities
• Communicate with internal and external stakeholders in a clear, professional, and concise manner, translating complex enrollment requirements into actionable information
• Organize and maintain practitioner files with meticulous attention to confidentiality guidelines and data security

Strategic Contribution:

• Develop in-depth knowledge of health plan standards and departmental procedures, effectively identifying and communicating issues, trends, and concerns to team members and cross-functional partners
• Support the Department Director in developing short and long-range strategic plans, contributing to departmental continuity and organizational objectives
• Demonstrate professional interactions with practitioners and external customers, representing the organization with integrity and expertise

Impact: This role is critical to ensuring providers are appropriately enrolled, compliant, and able to bill for services without interruption, directly supporting patient access and organizational revenue integrity.

Qualifications

EDUCATION/EXPERIENCE REQUIRED:

• High School Diploma required. Associate’s Degree preferred.
• 2-5 years of provider enrollment provider billing or credentialing experience required.
• High level of energy to work in a fast paced constantly changing environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking.
• Ability to work under minimal supervision.
• Ability to perform detail work efficiently and with a high degree of accuracy.
• High organized.
• Strong business acumen.
• Excellent verbal and written communication skills.
• Ability to interpret information and make judgments quick
• Ability to interact professionally with practitioners and other external customers
• Strong quantitative and analytical skills.
• Computer proficient in Microsoft Office including: Outlook, Word and Excel.
• Proficient in EPIC, Morrisey.

WORK ENVIRONMENT:

• Works in a normal office environment where there is no physical discomfort due to temperature, dust, noise, and the like.
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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