Provider Enrollment Specialist

We are seeking a Provider Enrollment Specialist II to support provider enrollment operations for a healthcare program. This role is responsible for conducting operational audits, reviewing provider enrollment applications, and ensuring compliance with state regulations and established business requirements. The ideal candidate will have experience in healthcare administration, provider enrollment, credentialing, or related healthcare operations.

Responsibilities

• Process provider enrollment applications to ensure compliance with applicable state regulations and program requirements.
• Validate qualifications of licensed professionals, organizational members, and healthcare organizations.
• Determine whether providers meet established qualifications, requirements, and standards to deliver services.
• Conduct and review background screenings using designated verification systems and resources.
• Verify licensure, certifications, endorsements, and accreditations through appropriate licensing boards and verification sources.
• Deny or escalate applications that do not meet eligibility requirements.
• Maintain established quality and productivity standards.
• Accurately document findings and enrollment decisions.

Qualifications

• Minimum of 2 years of administrative experience.
• Knowledge of healthcare operations, provider enrollment, or credentialing processes.
• Experience working with healthcare-related systems and databases.
• Understanding of provider enrollment requirements and compliance standards.
• Proficiency with Microsoft Office Suite.
• Strong organizational skills and attention to detail.
• Ability to manage multiple priorities while maintaining accuracy.

Preferred Qualifications

• Provider credentialing or enrollment experience.
• Customer service experience.
• Experience utilizing verification tools, databases, and document management systems.
• Strong verbal and written communication skills.
• Ability to interpret and apply policies, procedures, and regulatory requirements.

Why This Opportunity?

This role offers the opportunity to support critical healthcare operations by ensuring providers meet regulatory and program requirements. Ideal for professionals with administrative, healthcare, credentialing, or compliance experience who enjoy detailed review work and making informed enrollment determinations.