Enrollment Specialist

Job not on LinkedIn

🔥 1 minute ago

🏄 California – Remote

🏄 California – Remote

💵 $33 - $37 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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UCSF Health

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

📚 Education

Healthcare • Education

UCSF Health is an academic health system and medical center affiliated with the University of California, San Francisco that provides advanced specialty and primary care, hospital services, and regional outpatient locations across Northern California. It emphasizes highly specialized expertise (heart & vascular, cancer, orthopedics, neurology, transplant and more), operates hospitals and clinics, runs clinical trials and research programs, offers second opinions and international services, and focuses on research, innovation and education through UCSF’s schools of medicine, nursing, pharmacy and dentistry. UCSF Health positions itself as delivering world-class medicine and compassionate care, including urgent and emergency services, virtual care, and patient support services.

📋 Description

• Coordinate and monitor initial and ongoing provider enrollment applications with commercial health plans, Medicare, Medi-Cal, and other applicable payers. • Track enrollment applications from submission through completion and maintain accurate status documentation. • Conduct follow-up with health plans and payer representatives regarding pending applications, missing information, processing delays, and enrollment determinations. • Identify enrollment issues and discrepancies and collaborate with internal departments and payer representatives to resolve them. • Monitor requests for additional documentation and ensure required information is obtained and submitted timely. • Maintain enrollment tracking systems, databases, spreadsheets, and payer records. • Escalate delayed, denied, or problematic enrollments to leadership. • Assist with provider demographic and practice location updates across payer systems. • Support provider credentialing and recredentialing activities. • Maintain provider affiliations, specialties, addresses, tax identification information, NPI information, and other payer-required data. • Ensure accurate provider information in CAQH, PECOS, NPPES, payer portals, and other systems. • Review provider information and identify discrepancies between internal records and payer databases. • Assist with provider roster reconciliation and coordinate corrections. • Support credentialing and enrollment-related projects. • Assist with HICE audits and other compliance reviews. • Gather, organize, validate, and maintain enrollment and credentialing documentation for audits. • Review provider files for missing, incomplete, or inconsistent information. • Track audit action items and support completion of documentation requests. • Maintain records for audit readiness and regulatory compliance. • Maintain accurate, complete, and confidential provider enrollment records. • Document enrollment activities and payer communications. • Prepare enrollment reports and status updates. • Identify recurring payer issues, enrollment trends, and process improvement opportunities. • Adhere to organizational policies, payer requirements, and regulatory standards. • Collaborate with Credentialing, Contracting, Billing, Operations, and other stakeholders.

🎯 Requirements

• High school diploma or equivalent required. • Associate's degree or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred. • Two (2) or more years of experience in provider enrollment, credentialing, healthcare administration, medical group operations, payer operations, or a related healthcare environment preferred. • Experience working with commercial and/or government health plans preferred. • Experience using payer portals and provider databases preferred. • Proficiency with Microsoft Office applications, including Excel, Word, and Outlook. • Knowledge of provider enrollment and payer participation processes. • Knowledge of commercial and government payer requirements. • Knowledge of CAQH, PECOS, NPPES, payer portals, and provider roster management. • Knowledge of provider credentialing and recredentialing processes. • Knowledge of healthcare compliance requirements and audit documentation practices. • Knowledge of HICE audit standards and processes. • Knowledge of provider demographic, affiliation, TIN, and NPI maintenance. • Ability to protect confidential provider, patient, organizational, and business information.