Lead Provider Enrollment Specialist

Rural Physicians Group is an expansive physician network of rural-focused hospitalist, surgicalist and APPs that are passionate about helping rural hospitals meet the needs of the communities we serve.  By working with Rural Physicians Group, our hospital partners receive full-time dedicated providers on site, filling a critical void in care coverage and allowing for better patient outcomes.  Better outcomes lead to expanded inpatient services. Expanded inpatient services revitalize the hospital.  And a revitalized hospital improves the entire community.

RPG’s mission is, “Bringing rural hospitals and providers together to enhance the care of their community.”

We are currently seeking a full time Lead Provider Enrollment Specialist to help us with this mission. 

Job Overview

The Lead Provider Enrollment Specialist is responsible for overseeing and coordinating the daily operations of the provider enrollment team to ensure timely, accurate, and compliant enrollment of individual physicians and physician groups with Medicare, Medicaid, and Commercial payers. This role serves as the subject-matter expert for enrollment processes, supports team members with complex issues, ensures quality standards are met, and collaborates with internal stakeholders to maintain seamless enrollment workflows.

Essential Duties & Responsibilities

May lead, perform, or oversee the following duties based on organizational needs:

Leadership & Oversight

• Provide day-to-day guidance, support, and direction to Provider Enrollment Specialists.
• Assign and monitor workload, ensuring tasks are completed accurately and within required timelines.
• Serve as the primary escalation point for enrollment issues, payer challenges, or delays.
• Train new staff members and assist in developing training materials, SOPs, and best practices.
• Maintain high-level awareness of payer requirements, regulatory changes, and enrollment standards; communicate updates to the team.
• Mentor, coach, and onboard team members to elevate overall team capability and performance
• Serve as a subject matter expert and go-to resource for complex or escalated issues
• Anticipate challenges and propose proactive solutions

Enrollment Operations

• Ensure all providers are fully and accurately enrolled with Medicare, Medicaid, and Commercial payers in alignment with organizational timelines.
• Review and approve enrollment applications prior to submission to guarantee accuracy and completeness.
• Oversee the maintenance of detailed provider files, ensuring licenses, SSNs, tax IDs, and credentialing documentation are up to date.
• Monitor CAQH profiles for all providers and ensure timely attestation and updates.
• Manage tracking systems to prevent lapses in enrollment and reduce claim denials related to provider setup.

Communication & Collaboration

• Partner with internal departments to ensure smooth onboarding and changes to provider status.
• Respond to escalated correspondence or inquiries from providers and payers regarding enrollment status or issues.
• Support leadership with reporting, metrics, and operational updates related to enrollment activities.

Quality, Compliance & Process Improvement

• Ensure all workflows meet departmental, state, and federal regulatory requirements.
• Maintain strict confidentiality of provider and patient information in compliance with HIPAA.
• Identify areas for process improvement and recommend solutions to streamline enrollment operations and enhance accuracy.
• Assist with special projects or additional duties as needed.

Skills & Qualifications – Required

• Strong knowledge of Medicare, Medicaid, and Commercial payer enrollment processes.
• Ability to lead and support a team in a fast-paced, frequently changing environment.
• Excellent attention to detail, decision-making, and problem-solving abilities.
• Exceptional organizational skills with the ability to prioritize and coordinate multiple tasks.
• Strong written and verbal communication skills, including the ability to de-escalate difficult conversations.
• Ability to work independently while also collaborating effectively with other departments.
• Experience maintaining confidentiality and adhering to HIPAA guidelines.
• Proficiency with provider enrollment systems, patient accounting systems, and general computer applications.
• Minimum 3–5 years of Provider Enrollment experience in a healthcare setting, including demonstrated leadership or mentorship responsibilities.

Skills & Qualifications – Preferred

• Associate degree, industry certification(s), or Bachelor's degree in Business, Accounting, Finance, Healthcare Administration, or related field.
• Prior experience in a lead, senior, or supervisory role within enrollment or credentialing.
• Team Support & Leadership
• Serve as a senior resource to the Provider Enrollment team by supporting training, mentoring new staff, and providing expert guidance on payer-specific requirements.
• Assist leadership in refining workflows, improving processes, and implementing operational efficiencies.
• Collaborate closely with internal departments—including Billing, Compliance, HR, and Operations—to resolve complicated enrollment issues and ensure seamless onboarding.
• Support leadership with departmental reporting, process audits, and special projects as assigned
  

Benefits:

• Competitive salary
• Incentivized bonus plan
• Ability to work remotely from home 
• Three weeks of paid time off, accrual starting first day
• Comprehensive medical, dental, and vision insurance plans
• 401(k) with company match
• Health Savings Account
• Basic Life Insurance coverage
• Cell Phone Allowance