Provider Enrollment Specialist II

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Job Description

The Provider Enrollment Specialist II is responsible for both the initial licensure and Medicare and Medicaid enrollments for all hospitals, as well as the associated renewals and revalidations. This role serves as a liaison with our hospitals and the applicable regulatory agencies throughout the licensure and enrollment processes. The incumbent performs detailed statutory and regulatory research and interpretation to inform and develop strategic plan to meet company goals, and implements the plans to influence agency action. The Specialist develops filing timelines, and coordinate with hospitals, regional, and home office leaders to accurately complete filings, ensuring that hospitals are able to operate as planned. The Specialist participates in development meetings and calls to keep internal stakeholders apprised of progress, and works with leaders to resolve any concerns. Likewise, the incumbent works with established hospitals to ensure that all licenses are renewed and enrollments are revalidated, preventing any lapse in operations. The Specialist works with hospital, regional, and home office leaders to ensure that any concerns regarding licensure or enrollments are resolved expeditiously through statutory and regulatory research, the development of strategic plans, and the leveraging of relationships at state and federal agencies. The Provider Enrollment Specialist II is assigned moderately complex projects, and may serve as a resource to other Specialists in the completion of regulatory research and filings.

  • Demonstrates understanding of Medicare/Medicaid/Federal Workers’ Compensation programs and their significance to hospitals /the company.
  • Researches various topics, draws reasonable conclusions, and presents findings clearly and concisely.
  • Reviews statutory and regulatory updates and communicates the associated impacts to stakeholders.    
  • Responds articulately and timely to all questions and requests.
  • Understands provider enrollment’s role in Medicare/Medicaid processes.
  • Completes regulatory filings in a timely manner, and with excellence. Requires little assistance with routine filings. Maintains responsibility for two regions, but may be assigned additional projects outside of the assigned regions.
  • Understands the Joint Commission’s role in the provider enrollment process. Ensures all documentation needed to secure an initial or extension survey has been provided and works with new hospitals to ensure that Joint Commission approval letters are promptly communicated. 
  • Consistently demonstrates the department and company mission and values, and encourages the same in others. 
  • Maintains knowledge of systems used in provider enrollment process, both internal and external. Communicates the potential to improve internal systems to supervisor, and may participate in calls with CMS to discuss recommendations to federal enrollment systems.
  • Ensures proper storage of documents to ensure confidential or sensitive information is secured.
  • Conducts peer review of regulatory filings to identify potential issues or errors. 
  • Participates in, or leads, selected special projects, including potential CHOW and de novo projects. This includes performing research to determine the applicable licensure and enrollment requirements.

Job Code: 100205



Minimum Qualifications:

  • Bachelor’s degree and a minimum 1 year of provider enrollment experience, or a license to practice law or eligibility to sit for bar exam.
  • Working knowledge of Microsoft Office products, particularly Excel and Word

Machines, Equipment Used:

  • General office equipment such as computer/laptop, telephone, copy/fax machine, calculator, scanner, etc.
  • Microsoft Office software, to include Outlook, Word, and Excel.

Physical Requirements:

  • Visual acuity, speech recognition, speech clarity.
  • Ability to lift, lower, push, pull, and retrieve objects weighing a minimum of 15 pounds. Reasonable assistance may be requested when lifting, pushing, and/or pulling exceeds these minimum requirements.

Skills and Abilities:

  • Oral communication, written communication, fluency in English, active listening.
  • Information ordering, deductive reasoning, social perceptiveness, interpersonal skills, time management, critical thinking.
  • Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner.
  • Ability to work independently without continuous supervision.
  • Ability to research and accurately interpret statutes and regulations.

Environmental Conditions:

  • Indoor, temperature controlled, smoke-free environment.
  • Handicapped accessible.
  • May work under stressful circumstances at times.

Proficiency or Productivity Standards:

  • Has regular, reliable, and predictable attendance and punctuality.
  • Adheres to dress code including wearing ID badge.
  • Adheres to Standards of Business Conduct.
  • May be required to work weekdays and/or weekends, evenings and/or night shifts if needed to meet deadlines.
  • May be required to work on religious and/or legal holidays on scheduled days/shifts.
  • May be required to perform other duties as assigned by supervisor.
  • This position will support cultural diversity by promoting and maintaining an inclusive work environment and culture that is respectful and accepting of diversity.

Address: ,
Shift: Day Job
Schedule: Full-time
Job ID: 2119247