Enrollment Specialist

About the role

Petaluma Health Center provides high-quality health care in Southern Sonoma County and West Marin. As Enrollment Specialist you will maintain accurate provider, facility and payer enrollments so that reimbursement remains uninterrupted and regulatory compliance is met. You coordinate applications, revalidations, changes, payer communications, record maintenance and credentialing support, working with providers, Human Resources, Revenue Cycle, Finance, the credentialing team and payer organizations.

Key responsibilities

• Prepare, submit and track provider and facility enrollment applications, and coordinate initial enrollments, revalidations, reactivations, changes and terminations.
• Maintain enrollment records, supporting documentation and required signatures, and monitor application status with payers.
• Keep providers enrolled with Medicare, Medi-Cal, managed care plans, commercial payers and other contracted plans, and watch enrollment deadlines and revalidation requirements.
• Ensure compliance with federal, state, payer and organizational requirements and protect confidential information.
• Serve as the main contact for enrollment questions, share status updates and work with the credentialing team and payer credentialing departments.
• Keep provider data accurate in payer portals and help add it to Epic, and maintain enrollment tracking logs.
• Manage the CAQH portal, update the NPI registry, track expiring licenses and certifications, manage taxonomy codes, and process offboarding and disenrollment.
• Recommend workflow improvements and take part in system enhancements and audits.

Required profile

• High school diploma or equivalent.
• Preferred: provider enrollment, payer relations, credentialing support or healthcare revenue cycle experience; FQHC and Epic/OCHIN experience preferred.
• Preferred: knowledge of Medicare, Medi-Cal, managed care and commercial payer enrollment.
• Preferred: experience with payer portals such as PECOS, PAVE and CAQH.

Required skills

• Organizational, project management and attention to detail skills.
• Excellent written and verbal communication.
• Ability to manage multiple priorities independently and collaboratively.

What we offer

• 21 days of paid time off and 10 observed holidays.
• Medical, dental and vision insurance, with chiropractor and acupuncture visits included.
• Gym membership discounts, 401K matching after 1 year, flexible spending accounts, life insurance, long-term disability and an employee assistance program.