The Sr. Provider Enrollment Specialist plays a critical role in ensuring healthcare providers are properly enrolled and credentialed with insurance payers, regulatory bodies, and internal systems to facilitate timely reimbursement and compliance. This position is responsible for overseeing the entire provider enrollment lifecycle—including initial credentialing, recredentialing, and demographic updates—while serving as a subject matter expert for internal teams. The Sr. Specialist will work collaboratively with payer representatives, provider relations, and revenue cycle teams to resolve complex enrollment issues and improve enrollment timelines, contributing to overall revenue integrity and operational efficiency.
Provider Enrollment & Credentialing:
- Manage and execute provider enrollment and recredentialing processes with commercial, Medicare, and Medicaid payers.
- Ensure accurate and timely submission of enrollment applications and supporting documentation.
- Monitor enrollment timelines, proactively following up with payers to avoid delays in reimbursement.
- Maintain current knowledge of payer enrollment requirements, regulations, and industry standards.
Data Management & System Updates:
- Accurately enter and maintain provider demographic and credentialing information in internal databases and payer portals.
- Audit provider files and systems regularly to ensure accuracy and compliance.
- Track and manage license renewals, CAQH attestation, NPI registrations, and other provider data elements required for successful enrollment.
- Maintain acute understanding of billing and schedule system enrollment configurations.
Issue Resolution & Payer Communication:
- Act as a liaison between payers, providers, and internal stakeholders to resolve enrollment issues, rejections, and lapses in network participation.
- Escalate complex issues appropriately while maintaining thorough documentation and communication.
- Collaborate with billing and denial management teams to resolve enrollment-related claim denials.
Compliance & Documentation:
- Ensure compliance with all federal, state, and payer-specific guidelines related to provider enrollment.
- Maintain detailed and organized records of all enrollment activities, correspondence, and approval letters.
- Support audits and internal reviews by providing documentation and insight into provider status.
Collaboration & Cross-Functional Support:
- Partner with Revenue Cycle, Provider Relations, and Credentialing teams to align enrollment efforts with organizational needs.
- Provide subject matter expertise and mentorship to junior team members regarding enrollment best practices and processes.
- Contribute to ongoing process improvements to enhance the accuracy, speed, and efficiency of provider onboarding and enrollment.
Required Qualifications:
- Associate’s degree in Healthcare Administration, Business, or related field required (Bachelor’s preferred).
- Minimum of 3-5 years of experience in provider enrollment, credentialing, or revenue cycle operations.
- Strong understanding of payer enrollment processes for commercial, Medicare, and Medicaid plans.
- Experience working with provider enrollment portals (e.g., PECOS, CAQH, Availity) and electronic credentialing systems.
- Ability to analyze enrollment data and resolve complex payer or application issues effectively.
- Proficiency in Microsoft Office Suite and experience with healthcare information systems (EHR, practice management systems).
Preferred Qualifications:
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).
- Experience in a multi-specialty medical group or health system.
The base salary range for this full-time position is $60,500 – $79,200 per year in the United States. This posted range reflects the portion of our internal salary band that is currently funded for new hires in this role across our standard labor markets (Zones A–C).
For context, these markets include Zone A (e.g., Phoenix AZ, San Antonio TX, Columbus OH, Charlotte NC), Zone B (e.g., Chicago IL, Denver CO, San Diego CA, Houston TX), and Zone C (e.g., Los Angeles CA, Seattle WA, Washington, D.C., Boston MA). At this time, we are not budgeting for hires in higher-cost Zone D markets (e.g., San Francisco Bay Area CA, New York City NY, San Jose CA) for this role. Within this range, individual pay is determined by work location, skills, experience, and internal equity. We use structured salary bands and geographic zones based on cost of labor to keep pay fair and consistent.Skills Required
- Associate's degree in Healthcare Administration, Business, or related field required
- Minimum of 3-5 years of experience in provider enrollment, credentialing, or revenue cycle operations
- Strong understanding of payer enrollment processes for commercial, Medicare, and Medicaid plans
- Experience working with provider enrollment portals and electronic credentialing systems
- Ability to analyze enrollment data and resolve complex payer or application issues effectively
- Proficiency in Microsoft Office Suite and experience with healthcare information systems
Included Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Included Health and has not been reviewed or approved by Included Health.
-
Healthcare Strength — Comprehensive medical, dental, and vision coverage with employer-paid contributions and free access to the company’s own services enhances total rewards. Feedback suggests robust mental health support, telemedicine, and wellness programs strengthen perceived care quality.
-
Parental & Family Support — Paid parental leave and family-building benefits, including fertility coverage and financial assistance for adoption and surrogacy, are seen as meaningful supports. Feedback suggests compassionate leave and free family access to care add tangible value for caregivers.
-
Leave & Time Off Breadth — Flexible, non‑accrued vacation, generous PTO, paid volunteer time, floating holidays, and sabbaticals are consistently emphasized. Feedback suggests remote‑friendly flexibility and additional rest days during high‑stress periods improve work-life balance.
Included Health Insights
What We Do
Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.
Why Work With Us
Here, initiative meets purpose. We have bold aspirations that drive our work. We care in a way that shows in everything we do. At Included Health, you will join a team that is propelled by the opportunity to redefine healthcare for all. It's work worth caring about.
Gallery
