Provider Enrollment Specialist

Base Pay Range: $22.00 - $33.00 Job Description: Join the team that delivers a Healthier Bottom Line. Our purpose at InlandRCM is to strengthen rural hospitals by providing dependable, all-American revenue cycle expertise that sustains access to quality healthcare in rural communities. Hours are 8am-5pm PST Monday-Friday. We are seeking a skilled Provider Enrollment Specialist to join our growing team and play a key role in supporting new client partnerships and the expansion of essential revenue cycle services for rural healthcare organizations. The Provider Enrollment Specialist is responsible for managing the full lifecycle of provider and facility enrollment with commercial, government, and managed care insurance payers. This role ensures that all practitioners and facilities are properly credentialed and enrolled to receive reimbursement for rendered services. In addition, the Provider Enrollment Specialist performs primary source verification (PSV) functions to support the credentialing process in accordance with regulatory standards, accreditation requirements, and organizational policies. This position plays a critical role within the revenue cycle workflow, directly impacting the organization's ability to bill and collect for services in a timely and compliant manner. Essential Duties/Responsibilities: Provider & Facility Enrollment: - Initiate, complete, and submit enrollment applications for individual providers and facilities with Medicare, Medicaid, and commercial insurance payers via paper and electronic methods (PECOS, CAQH, payer portals). - Manage the re-enrollment, revalidation, and maintenance of existing provider records to ensure continuous billing privileges. - Coordinate with providers, practice administrators, and facility leadership to obtain required documentation, signatures, and information necessary to complete enrollment applications. - Track and monitor enrollment application status through completion, resolving payer inquiries and deficiencies in a timely manner. - Maintain accurate and up-to-date records of all enrollment activity within the enrollment tracking system, including effective dates, payer IDs, and contract terms. - Process provider demographic changes, including address updates, group affiliations, NPI associations, and taxonomy changes with all applicable payers. - Collaborate with billing, contracting, and credentialing teams to ensure alignment of enrollment data and prevent billing denials attributable to enrollment issues. - Research and resolve enrollment-related claim denials and payment delays in coordination with the billing department. - Maintain knowledge of Medicare, Medicaid, and commercial payer enrollment regulations, policies, and procedures. Primary Source Verification (PSV) - Conduct primary source verification of provider credentials including medical licenses, board certifications, DEA registrations, education and training, and malpractice history, in compliance with NCQA, URAC, TJC, or applicable accreditation standards. - Utilize verification resources such as state medical boards, NPDB (National Practitioner Data Bank), AMA Physician Masterfile, ABMS, and other primary sources to obtain verification of credentials. - Document all PSV activities within the credentialing database or provider credentialing file in an accurate, complete, and timely manner. - Flag and escalate discrepancies, sanctions, exclusions, or adverse findings identified during the verification process to the Credentialing Committee or Revenue Cycle Manager. - Monitor expirable credentials (licenses, certifications, malpractice coverage) and initiate re-verification processes in advance of expiration dates. - Ensure PSV processes comply with organizational policies, regulatory requirements (OIG, SAM/LEIE exclusion lists), and applicable state and federal law. General & Administrative: - Maintain organized and audit-ready enrollment and credentialing files for all providers and facilities. - Participate in payer audits, internal audits, and accreditation surveys as required. - Generate and distribute enrollment status reports and metrics to management on a regular basis. - Stay current on changes to payer enrollment requirements, CMS regulations, and credentialing standards through ongoing education and training. - Assist with onboarding new provider clients, including education on enrollment timelines and requirements. - Perform other duties as assigned by management in support of revenue cycle operations. Minimum Qualifications Education: - High School Diploma/GED required - Two-year medical billing course is desired Experience: · Minimum of 2–3 years of experience in provider enrollment, credentialing, or a related healthcare revenue cycle role required. · Experience working with Medicare (PECOS), Medicaid, and commercial payer enrollment processes required. · Experience performing primary source verification in a credentialing or managed care environment preferred. · Experience with a multi-specialty or multi-facility provider environment preferred. Certifications: - Certified Provider Credentialing Specialist (CPCS) — National Association Medical Staff Services (NAMSS) - Certified Professional in Medical Staff Management (CPMSM) — NAMSS - Certified Revenue Cycle Representative (CRCR) — HFMA Background Check: o Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults o In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Inland Imaging Business Associates will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG). Employees must not be included on this list. · Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test. · Ability to work from a remote location (home). · Required to have a dedicated area to perform the job, that is private and has a desk, chair, appropriate lighting, and access to internet. Summary:  Completes payer enrollment for facilities and practitioners. General Description:  Responsible for all phases of enrolling facilities and practitioners with insurance and government payers. Essential Duties/Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - Gathers forms and data requirements from individual payers and compiles data from facilities and practitioners at client sites. - Completes all paper and on-line forms and disseminates forms to the facilities and physicians with the appropriate instructions. - Reviews all returned forms for accuracy and completeness. - Sends applications and enrollments to the individual payers and follows through with both the clients and the payers in a timely manner to procure proper enrollments. - Interprets enrollment regulations accurately and in keeping with federal, state and third party billing regulations and policies.            - Prioritizes outstanding enrollments appropriately. - Other special projects and duties as assigned. General Duties/Responsibilities: - Ability to maintain strict confidentiality within the Inland Imaging companies and Inland’s customers. - Honest, pleasant manner and good personal hygiene. - Free of alcohol and drug abuse. - Valid state driver’s license and proof of insurance. - Excellent communication and interpersonal skills. - Detail oriented; ability to multi-task; organized and able to work in a fast paced environment. - Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc. - Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance. - Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department. - Follows all Health and Safety policies and guidelines of Inland Imaging and its partners depending on work location - Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities. - Attendance is required for this position. - Rotates to other shifts and locations as needed. Supervisory Responsibilities: - There is little or no supervisory responsibility in this position Advocacy: Treats all clients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values: - Show We Care, Do The Right Thing, Maximize Individual Potential, Always Aim Higher Qualifications:   - Education: High School Diploma/GED required- Two year medical billing course is desired - Experience: At least 2 years of experience in billing requirements for either government or commercial insurers, preferably experience in hospital billing, but will accept equivalent in physician billing or experience in provider enrollment. - Licensure:   N/A - Certifications:  N/A - Computer Skills:  Experience with the following computer applications is highly desired: Microsoft Office products (Outlook, Word, Excel), Kronos; Replicon; Internet, Intranet, Meditech, Healthland, Techtime, EMDs, Epic or other hospital or physician accounting system. - Background Check:- Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults - In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Inland Imaging Business Associates will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG).  Employees must not be included on this list.   - Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test which includes marijuana. Nuvodia/Inland is an EEO employer...