Provider Enrollment Specialist

Title: Pod Captain, Provider Enrollment (Remote)

Location: Melville,NY - USA

Job Description:

Full time

job requisition id :JR10822

Position Requirements

The Provider Enrollment Pod Captain is responsible for overseeing the daily operations of a designated provider enrollment group and all credentialing functions. This role assigns and prioritizes tasks, monitors work queues, and ensures specialists consistently meet enrollment timelines, productivity targets, and quality standards. Serving as a subject matter expert and first point of escalation, the Pod Captain provides support on complex issues, payer research, and denial trends while collaborating with leadership to implement solutions and reinforce policies and workflows.

The Pod Captain also plays a key role in staff development by training new and existing employees, reviewing and auditing work for accuracy, and delivering timely feedback to drive performance. Additional responsibilities include contributing to performance evaluations, approving timecards, and participating in system testing, workflow updates, and process improvement initiatives.

The ideal candidate will bring a strong knowledge of payer enrollment processes along with excellent organizational, problem solving, and communication skills to ensure efficient, accurate, and compliant provider enrollment operations.  

PRIMARY RESPONSIBILITIES:

Oversight: Serve as the primary point of contact for Provider Enrollment Specialists. Assign, monitor, and prioritize work to ensure timely completion of enrollment tasks. Serves as a subject matter expert (SME) and first line of support for complex, high-priority or escalated issues. Assist with the development and maintenance of departmental policies and procedures. Support training and onboarding for new and existing Provider Enrollment Specialists. Develop and maintain procedural training documents and manuals to assist specialists in the efficient and accurate completion of their assigned duties.

Operational Execution: Monitors’ performance metrics (e.g., Athena tasks, rejections, hold and QGenda), assist specialist with work backlog and provide feedback to staff. Ensure provider data is entered and maintained accurately in internal systems and payer portals while ensuring new and re-enrollments are processed timely.

Process and Compliance: Ensure pod adherence to established policies, payer requirements, and regulatory standards. Identify denial trends, enrollment obstacles, payer-related issues, and Athena system items; partner with leadership to implement solutions. Assist in meeting delegated credentialing agreements, NCQA, MCO, CMS and other regulatory requirements for provider enrollment credentialing as needed. Track and monitor productivity, conducts quality assurance audits and provide feedback and recommendations to specialists. Participate in workflow updates, system testing, and process improvement initiatives.

Collaboration and Communication: Collaborate with other Pod Captains, leadership, and cross-functional teams (Credentialing, AR, Billing, etc.) to resolve issues impacting enrollment. Communicate updates, changes in payer requirements, or process modifications to the team. Contribute input for annual performance evaluations and staff development plans.

Time and Attendance: Perform delegated duties related to PTO requests, maintenance of required staffing levels, Workday time submissions, and related administrative duties pertinent to payroll and attendance tracking.

REQUIRED QUALIFICATIONS

•5+ years of experience in provider enrollment, credentialing or healthcare revenue cycle.

•Strong working knowledge of provider data management systems, CAQH, PECOS, NPPES, and payer portals.

•Proficiency in Microsoft Office Suite, especially Excel (VLOOKUPs, pivot tables), Word, PowerPoint and Outlook

•Thorough understanding of CMS regulations, payer credentialing standards, and industry best practices

•Knowledge of revenue cycle functions and the impact of enrollment on billing and collections

•Excellent verbal and written communication skills, including presentation and facilitation in both one-on-one and group settings.

•Strong organizational and time management skills

•Ability to communicate with clarity, transparency, and professionalism across all levels of the organization.

•Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change

•Ability to make sound decisions with limited supervision

•Demonstrated ability to effectively motivate and inspire staff to achieve peak performance and professional growth.

DESIRED/PREFERRED QUALIFICATIONS:

•Familiarity with EHR or practice management systems (e.g., AthenaIDX, Epic, etc.) preferred.

•Proven ability to lead process improvement initiatives or enrollment system implementations

•Expertise in payor enrollment and claims processing related to Government and Commercial payers

Total Rewards

• Salary: $21.89-$30.10 hourly
• Generous benefits package, including:
• Paid Time Off
• Health, life, vision, dental, disability, and AD&D insurance
• Flexible Spending Accounts/Health Savings Accounts
• 401(k)
• Leadership and professional development opportunities