Job Description

We are seeking an experienced Enrollment Specialist to manage payer enrollment activities across multiple lines of business, including Medicaid (Georgia), Medicare, Tricare, and Molina. This role is responsible for end-to-end provider enrollment, revalidation, and maintenance, ensuring timely and accurate submissions while maintaining compliance with payer and regulatory requirements. The ideal candidate is a self-starter who can work independently, navigate payer portals efficiently, and manage a high-volume workload with minimal supervision.

Key Responsibilities:

• Manage full-cycle provider enrollment and revalidation processes for Medicaid (Georgia), Medicare, Tricare, and Molina
• Prepare, submit, and track enrollment applications through various payer portals and systems
• Maintain accurate and up-to-date provider records in internal databases and payer systems
• Monitor application status, follow up with payers, and resolve enrollment issues or delays proactively
• Ensure compliance with all federal, state, and payer-specific requirements and timelines
• Collaborate with internal teams (credentialing, operations, contracting) to ensure alignment and timely onboarding
• Identify process gaps and recommend workflow improvements to enhance efficiency and turnaround times
• Maintain detailed documentation and reporting on enrollment status and key metrics
• Stay current on payer requirements, portal updates, and regulatory changes

Qualifications:

• Minimum of 5 years of experience in provider enrollment
• Hands-on experience with Medicaid (Georgia), Medicare, Tricare, and Molina enrollment processes
• Strong working knowledge of payer portals and enrollment platforms (e.g., PECOS, state Medicaid portals, Tricare, etc.)
• Proven ability to manage multiple enrollments across locations and providers simultaneously
• Experience working in a high-volume, deadline-driven environment
• High level of accuracy and attention to detail

Skills & Competencies:

• Self-motivated with the ability to work independently and prioritize workload effectively
• Strong problem-solving skills and ability to navigate complex enrollment issues
• Excellent organizational and time management skills
• Clear and professional communication skills, both written and verbal
• Ability to adapt to changing processes and evolving payer requirements
• Proficiency in Microsoft Office and enrollment/credentialing systems

Preferred Qualifications:

• Experience supporting multi-state or multi-site healthcare organizations
• Experience with credentialing databases (e.g., MD-Staff, CAQH, or similar systems)

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