Senior Provider Enrollment Specialist

A5 Healthcare (Anders Affiliate) one of the fastest-growing Credentialing Verification Organizations in the country is seeking a Senior Provider Enrollment Specialist who is motivated to learn, excited to collaborate and passionate about delivering outstanding results. This individual will have a direct impact on our firm’s mission of serving as a catalyst for those striving to achieve their highest potential.

The Senior Provider Enrollment Specialist at A5 Services serves as a key leader in the credentialing and payer enrollment function for the Independent Physician Association (IPA). This advanced role is responsible for overseeing and executing complex enrollment processes, ensuring compliance with NCQA, URAC, and CMS accreditation standards, and providing mentorship and guidance to junior staff. The Senior Specialist acts as a subject matter expert and strategic partner across departments and with external payers to streamline and enhance the credentialing workflow. This position plays a critical role in maintaining operational excellence, regulatory compliance, and provider satisfaction.

What You’ll Do:

Advanced Provider Enrollment and Credentialing

• Lead the submission and oversight of complex and high-priority initial applications, reappointments, and recredentialing efforts.
• Conduct quality assurance reviews of credentialing documents and workflows to ensure accuracy and compliance.
• Serve as the primary liaison with health plans on escalated or time-sensitive enrollment matters.
• Oversee and improve payer tracking systems and credentialing databases; ensure all data is accurately maintained.
• Identify and address systemic issues in enrollment processes, recommending and implementing best practices.
• Support audits and accreditation activities by compiling data and documentation as needed.
• Assist leadership in developing policies and procedures for credentialing and payer enrollment functions.

Team Support and Leadership

• Provide mentorship and training to Payer Enrollment Specialists and new team members.
• Support team workload balancing by assisting in complex case management and troubleshooting.
• Collaborate cross-functionally with internal stakeholders such as compliance, provider relations, and operations.
• Represent the credentialing team in interdepartmental meetings and projects.

General Responsibilities

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