Job Description

Job Summary 

The Provider Enrollment Specialist ensures healthcare providers are properly credentialed and enrolled with payers, government programs, and healthcare networks. This role facilitates accurate and timely submission of applications, maintains compliance with payer requirements, and updates provider records to ensure the organization can bill for services rendered effectively. 

As a Provider Enrollment Specialist at Community Health Systems (CHS) - Physician Practice Support Inc. (PPSI), you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, flexible scheduling, and 401k.

Essential Functions

Prepares, reviews, and submits applications for provider enrollment and re-credentialing with insurance companies, Medicare, Medicaid, and other payers. Monitors and tracks enrollment and credentialing statuses, ensuring adherence to deadlines and compliance requirements. Updates and maintains accurate provider information in databases, payer systems, and organizational records. Communicates with providers, payers, and other stakeholders to resolve enrollment issues and provide updates on application statuses. Analyzes payer requirements and ensures applications meet regulatory standards and organizational policies. Collaborates with internal teams, including billing and compliance, to address issues impacting revenue cycle management. Identifies and implements process improvements to streamline provider enrollment and credentialing workflows. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

H.S. Diploma or GED required Associate Degree in Healthcare Administration, Business, or a related field preferred 2-4 years of experience in provider enrollment, credentialing, or a related role required Experience working with healthcare payers, Medicare/Medicaid regulations, and credentialing software preferred

Knowledge, Skills and Abilities

Strong knowledge of payer enrollment requirements, credentialing standards, and regulatory compliance. Proficiency in credentialing software and systems. Excellent organizational skills and attention to detail. Effective verbal and written communication skills. Ability to manage multiple priorities and meet deadlines.

Licenses and Certifications

Certified Provider Credentialing Specialist (CPCS) preferred

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

The PPSI Team and Athena work alongside the Clinic Leaders and staff with the common goal of creating a clean and efficient revenue cycle.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.