Strategic Provider Enrollment & Credentialing Specialist

Cibola Family Health Center; Grants (NM); On-site; USD 55,000 - 75,000; Full time

Job summary

Cibola Family Health Center in Grants, NM is seeking a Provider Enrollment Specialist to manage enrollment and re-enrollment with Medicare, Medicaid, and commercial payers. You will ensure timely and accurate enrollment to support reimbursement and compliance.

The role supports rural operations, maintains records in CAQH ProView, NPPES, and payer portals, coordinates with credentialing teams, and tracks status to prevent billing lapses.

Qualifications

• Associate's degree in Healthcare Administration or related field.
• 2–3 years in provider enrollment, credentialing, or medical billing.
• Experience with Critical Access Hospitals or rural healthcare preferred.
• Familiarity with PECOS, CAQH, NPPES, and Medicaid enrollment.
• Strong regulatory knowledge (HIPAA, COP).

Responsibilities

• Prepare and submit enrollment and re-enrollment applications to Medicare, Medicaid, and commercial payers.
• Coordinate CAH-specific enrollment and provider enrollments.
• Gather required documentation from providers and staff.
• Track status and respond to payer requests to secure timely approvals.
• Maintain enrollment records in CAQH ProView, NPPES, and payer portals.
• Monitor revalidation schedules and prevent lapses in billing privileges.
• Assist with denials and collaborate with billing to resolve issues.
• Serve as liaison between hospital, providers, and payers.
• Conduct audits of enrollment data for accuracy.
• Stay updated on payer policies and Medicare regulations.
• Support onboarding of new providers and locum tenens.
• Generate enrollment status reports for leadership.

Skills

HIPAA compliance

Regulatory knowledge

EHR/PM systems

Excel proficiency

Attention to detail

Communication skills

Problem solving

Integrity

Education

Associate’s degree in Healthcare Administration

Bachelor’s degree preferred

Tools

PECOS

CAQH ProView

NPPES

Enrollment software

Job description

Cibola Family Health Center in Grants, NM is seeking a Provider Enrollment Specialist to manage enrollment and re-enrollment with Medicare, Medicaid, and commercial payers. You will ensure timely and accurate enrollment to support reimbursement and compliance.

The role supports rural operations, maintains records in CAQH ProView, NPPES, and payer portals, coordinates with credentialing teams, and tracks status to prevent billing lapses.