The Provider Enrollment Senior Specialist is essential in ensuring that healthcare providers are correctly enrolled and credentialed with insurance plans, regulatory agencies, and internal systems so reimbursement and compliance requirements are met. This role oversees the full enrollment process—from initial credentialing to recredentialing and updating provider information—and serves as a key resource for internal teams. The Senior Specialist works closely with payer contacts, provider relations, and revenue cycle teams to resolve complex enrollment challenges, speed up processing times, and support overall revenue and operational performance.

Provider Enrollment and Credentialing Responsibilities:
• Oversee provider enrollment and recredentialing with commercial, Medicare, and Medicaid payers.
• Submit enrollment applications and documentation accurately and on schedule.
• Track enrollment progress and follow up with payers to prevent reimbursement delays.
• Stay current on payer rules, regulations, and industry standards for provider enrollment.

Data Management and System Updates:
• Enter and maintain provider demographic and credentialing details in internal systems and payer platforms.
• Regularly audit provider records to ensure accuracy and compliance.
• Manage license renewals, CAQH attestation, NPI updates, and other key data needed for enrollment.

Issue Resolution and Payer Communication:
• Serve as the main point of contact between payers, providers, and internal teams to address enrollment problems, rejections, and network participation issues.
• Escalate complicated situations when needed while keeping clear records and communication.
• Partner with billing and denial management teams to resolve enrollment-related claim issues.

Compliance and Documentation:
• Ensure all enrollment activities comply with federal, state, and payer-specific requirements.
• Keep thorough and organized documentation of enrollment actions, communication, and approval records.
• Provide documentation and insight during audits and internal reviews.

Collaboration and Cross‑Functional Support:
• Work with Revenue Cycle, Provider Relations, and Credentialing teams to align enrollment efforts with organizational goals.
• Offer expertise and guidance to less experienced team members on best practices.
• Support ongoing improvements to enhance accuracy, efficiency, and speed in provider onboarding and enrollment.

Required Qualifications:
• Associate’s degree in Healthcare Administration, Business, or a related field (Bachelor’s preferred).
• Three to five years of provider enrollment, credentialing, or revenue cycle experience.
• Strong knowledge of enrollment processes for commercial, Medicare, and Medicaid plans.
• Experience with enrollment portals such as PECOS, CAQH, and Availity, as well as electronic credentialing systems.
• Ability to analyze enrollment data and address complex application or payer issues.
• Proficiency with Microsoft Office and healthcare information systems such as EHR or practice management tools.

Preferred Qualifications:
• CPCS or CPMSM certification.
• Experience in a multi‑specialty medical group or health system.

Pay:
United States base salary targets for full‑time new hires:
Zone A: $22.84–$29.69 per hour plus equity and benefits
Zone B: $25.13–$32.66 per hour plus equity and benefits
Zone C: $27.41–$35.63 per hour plus equity and benefits
Zone D: $29.69–$38.60 per hour plus equity and benefits

Actual starting pay depends on factors such as education, experience, training, certifications, skills, organizational needs, internal equity, and geographic market data. Each zone has its own compensation structure to ensure fairness and competitiveness. Candidates may request information about their geographic zone from their recruiter.

Benefits and Perks:
Employees may receive, depending on the role:
• A remote‑first work environment
• 401(k) plan with Fidelity
• Comprehensive medical, dental, and vision insurance, including disability coverage
• Paid Time Off and Discretionary Time Off
• Twelve weeks of fully paid parental leave
• Family building and compassionate leave benefits, including fertility coverage and financial support for adoption or surrogacy
• Work‑from‑home reimbursement for home office support

Your recruiter will provide full details on salary and benefits during the hiring process.

About Included Health:
Included Health is a modern healthcare company focused on integrated virtual care and navigation. The mission is to improve healthcare access and quality for everyone, supporting individuals at every stage of their health journey. The company provides care guidance, advocacy, and convenient access to virtual and in‑person services spanning primary care, urgent care, behavioral health, and specialty care. More information is available at https://includedhealth.com.

Included Health is an Equal Opportunity Employer and evaluates all applicants without regard to protected characteristics under federal, state, or local law. The company also considers qualified applicants with arrest or conviction records in compliance with the San Francisco Fair Chance Ordinance, Los Angeles County Fair Chance Ordinance, and California law.