Included Health · 2 hours ago
Sr. Provider Enrollment Specialist
United States
Full-time
Remote
Mid, Senior Level
$22.84/hr - $38.60/hr
3+ years expIncluded Health is a new kind of healthcare company, delivering integrated virtual care and navigation. The Provider Enrollment Sr. Specialist plays a critical role in ensuring healthcare providers are properly enrolled and credentialed with insurance payers, overseeing the entire provider enrollment lifecycle and collaborating with various teams to resolve complex enrollment issues.
Health CareHospitalMedicalmHealth
Responsibilities
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
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
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
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
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
Qualification
Required
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
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
Experience in a multi-specialty medical group or health system
Benefits
Remote-first culture
401(k) savings plan through Fidelity
Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
Paid Time Off ("PTO") and Discretionary Time Off (“DTO”)
12 weeks of 100% Paid Parental leave
Family Building & Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies.
Work-From-Home reimbursement to support team collaboration home office work
Company
Included Health
Included Health provides a combination of virtual care, navigation, and communities-based healthcare services.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$344MKey Investors
The Carlyle GroupGreylockVenrock
2020-09-09Series E· $175M
2018-05-02Series D· $66M
2017-01-01Series Unknown
Leadership Team
Owen Tripp
Chief Executive Officer
Wade Chambers
CTO & SVP of Engineering
Recent News
2026-01-23
Company data provided by crunchbase