Sr. Provider Enrollment Specialist

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus.

Provider Enrollment

• Submit initial enrollments, revalidations, demographic updates, and terminations for healthcare providers with Medicare, Medicaid, and commercial health plans.
• Complete and maintain provider applications through payer portals and paper submissions as required.
• Monitor enrollment statuses and follow up with payers to ensure timely processing.
• Track enrollment requests and maintain accurate records within enrollment databases and tracking systems.
• Research and resolve enrollment issues, denials, and application discrepancies.

Credentialing and Compliance Support

• Collaborate with credentialing teams to obtain necessary documentation for enrollment applications.
• Verify provider eligibility and compliance with payer requirements.
• Ensure provider enrollment data remains current and compliant with regulatory standards.
• Assist with audits and maintain supporting documentation for accreditation and compliance reviews.

Provider and Payer Relations

• Serve as the primary point of contact for enrollment-related inquiries.
• Communicate effectively with providers, practice managers, credentialing staff, and payer representatives.
• Educate providers and operational teams regarding enrollment requirements and timelines.
• Establish and maintain professional relationships with payer representatives.

Data Management and Reporting

• Maintain accurate provider demographic information in enrollment databases and payer systems.
• Generate enrollment status reports and communicate updates to leadership and stakeholders.
• Monitor enrollment metrics and identify process improvement opportunities.
• Ensure timely documentation and tracking of all enrollment activities.

Problem Resolution

• Investigate enrollment delays and reimbursement impacts.
• Escalate complex enrollment issues as appropriate.
• Coordinate corrective actions to minimize billing interruptions and revenue loss.
• Partner with revenue cycle teams to resolve enrollment-related claim holds.

Qualifications

Education

• Associate degree preferred
• Equivalent combination of education and healthcare enrollment experience may be considered.

Experience

• Minimum of 2-3 years of provider enrollment, credentialing, medical staff services, or healthcare administration experience preferred.
• Experience working with Medicare, Medicaid, and commercial payer enrollment processes.
• Familiarity with CAQH, PECOS, NPPES, and payer credentialing systems.

Knowledge, Skills, and Abilities

• Strong understanding of healthcare payer enrollment requirements and regulations.
• Knowledge of credentialing, privileging, and provider data management processes.
• Excellent organizational and time management skills.
• Strong attention to detail and accuracy.
• Ability to manage multiple priorities and meet deadlines.
• Exceptional verbal and written communication skills.
• Proficiency with Microsoft Office Suite, payer portals, and enrollment tracking systems.
• Ability to work independently and collaboratively within a team environment.

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS) certification preferred.
• Certified Professional Medical Services Management (CPMSM) certification preferred.
• Experience in a large healthcare system, physician organization, or managed care environment.
• Knowledge of provider contracting and revenue cycle operations.

Physical Requirements

• Ability to work primarily in a sedentary office environment.
• Frequent use of computers and standard office equipment.
• Ability to communicate effectively via phone, video conferencing, and email.

Key Performance Indicators (KPIs)

• Timely submission of enrollment applications.
• Enrollment turnaround time.
• Enrollment approval rate.
• Reduction in claim holds related to enrollment issues.
• Accuracy of provider demographic data.
• Compliance with organizational and payer requirements.
• Customer service and stakeholder satisfaction.

This role is critical to ensuring providers are appropriately enrolled, compliant, and able to bill for services without interruption, supporting both patient access and organizational revenue integrity.