Provider Enrollment Specialist

Position Overview

Apex Dermatology is seeking a detail-oriented Provider Enrollment Specialist to support the enrollment, credentialing coordination, and maintenance of healthcare providers with insurance plans and other applicable payer networks.

This role is responsible for coordinating provider enrollment applications, maintaining accurate provider information, tracking application status, following up with payers, and ensuring required documentation is complete and organized.

The ideal candidate has strong administrative and organizational skills, understands healthcare documentation, and can manage multiple enrollment activities while meeting deadlines.

Key Responsibilities

Provider Enrollment

• Coordinate provider enrollment and re-enrollment activities with insurance payers.
• Prepare and submit provider enrollment applications and supporting documentation.
• Track enrollment applications from submission through completion.
• Follow up with insurance companies regarding pending applications.
• Maintain accurate records of enrollment status and effective dates.
• Identify incomplete applications and coordinate required corrections.

Provider Information Management

• Maintain accurate provider demographic and professional information.
• Update provider records when changes occur.
• Track provider identifiers, licenses, certifications, and other required information.
• Maintain organized electronic provider files.
• Ensure provider information is consistent across applicable systems and documents.

Credentialing Support

• Assist with gathering documentation required for credentialing and payer enrollment.
• Track expiration dates for licenses, certifications, and other required documents.
• Follow up with providers regarding missing or expiring information.
• Maintain credentialing checklists and status reports.
• Coordinate documentation requests with appropriate internal personnel.

Payer Communication

• Communicate with commercial insurance plans, government programs, and other payer organizations.
• Follow up on application status and outstanding requirements.
• Document communications with payer representatives.
• Maintain records of reference numbers, effective dates, and enrollment decisions.
• Escalate complex enrollment issues when appropriate.

Application Tracking & Follow-Up

• Maintain enrollment logs and tracking systems.
• Monitor pending applications and approaching deadlines.
• Follow up regularly on delayed applications.
• Identify potential barriers to provider enrollment.
• Communicate significant delays to management.
• Maintain accurate notes regarding follow-up activities.

Documentation Management

• Collect, organize, and maintain required provider documentation.
• Review documentation for completeness before submission.
• Maintain secure and confidential provider records.
• Scan, upload, and organize enrollment-related documents.
• Ensure required documentation is available when requested.

Dermatology Practice Support

• Coordinate with providers, clinical leadership, billing personnel, and administrative staff.
• Support enrollment activities for dermatologists and other eligible healthcare providers.
• Assist with maintaining provider participation information.
• Communicate enrollment status updates to appropriate internal departments.
• Help ensure provider enrollment information is available to support billing and patient access.

Compliance & Recordkeeping Support

• Follow established company procedures for provider documentation and record retention.
• Maintain confidentiality of provider information.
• Assist with internal reviews of enrollment records.
• Support documentation preparation for audits or payer reviews.
• Escalate regulatory, legal, or compliance-sensitive concerns to appropriate personnel.

Reporting & Administrative Support

• Prepare routine enrollment status reports.
• Maintain spreadsheets and provider tracking logs.
• Track completed, pending, and expiring enrollment activities.
• Identify recurring enrollment delays or documentation issues.
• Support special credentialing and provider operations projects as assigned.

Qualifications

Required

• High school diploma or equivalent.
• 1–3 years of experience in provider enrollment, credentialing, healthcare administration, medical billing, insurance, or a related field.
• Strong organizational and follow-up skills.
• Excellent attention to detail and accuracy.
• Strong written and verbal communication skills.
• Ability to manage multiple applications and deadlines.
• Proficiency with Microsoft Excel, Google Sheets, email, and standard business software.
• Ability to maintain confidential information.
• Strong documentation and record-management skills.

Preferred

• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
• Previous provider enrollment or credentialing experience.
• Experience working with commercial and government healthcare payers.
• Familiarity with CAQH or provider-data management systems.
• Experience in dermatology or another outpatient medical specialty.
• Knowledge of medical billing, payer enrollment, or revenue-cycle operations.
• Experience with provider credentialing software.

Core Competencies

• Provider Enrollment
• Credentialing Support
• Payer Communication
• Application Management
• Provider Data Management
• Documentation
• Follow-Up
• Healthcare Administration
• Insurance Coordination
• Recordkeeping
• Spreadsheet Management
• Confidentiality
• Organization
• Attention to Detail

Performance Expectations

Success in this role is demonstrated by:

• Accurate and timely submission of enrollment applications.
• Consistent follow-up on pending applications.
• Well-maintained provider records.
• Reduced delays caused by missing documentation.
• Accurate tracking of enrollment and effective dates.
• Professional communication with providers and payers.
• Timely identification of expiring documentation.
• Reliable support for credentialing and provider operations.

Pay: $24.82 - $29.90 per hour

Benefits:

• 401(k)
• Flexible schedule
• Health insurance
• Paid time off
• Retirement plan

Work Location: Remote