Provider Enrollment Team Lead

Summary

Join Circle Medical's Provider Enrollment Team as a Team Lead Specialist, overseeing the provider enrollment process to ensure timely and accurate enrollment with government and commercial payers and IPAs. You will play a critical role in the revenue cycle, combining hands-on enrollment expertise with leadership responsibilities. Guide a team of enrollment specialists to meet departmental goals, maintain compliance, and optimize the reimbursement process. Serve as a liaison between providers, payers, and internal departments, resolving complex issues and driving operational efficiency. Oversee the end-to-end provider enrollment process, ensuring accurate and timely submission of enrollment applications while maintaining compliance. Conduct internal audits and assist in policy development and process improvements.

Requirements

• Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred
• Minimum 5 years of experience in provider enrollment, credentialing, or healthcare administration
• Familiarity with payer-specific requirements, CAQH, NPPES, PECOS, and credentialing software
• Minimum of 1 year of people leadership/management experience
• Strong organizational and time management skills
• Attention to detail and accuracy in data entry and documentation
• Excellent written and verbal communication skills
• Proficient in Microsoft Office and enrollment portals
• Ability to work independently and as part of a collaborative team
• Detail oriented with string problem solving and analytical capabilities

Responsibilities

• Supervise, mentor and train a team of provider enrollment specialists, fostering a collaborative and high performing work environment
• Manage a team of specialists to ensure Complete and submit credentialing applications, re-credentialing forms, and maintenance updates as required by payers
• Assign tasks monitor team performance and ensure adherence to deadlines and quality standards
• Oversee the end-to-end provider enrollment process, including initial applications, re-enrollment, revalidation and updates for providers
• Ensure accurate and timely submission of enrollment applications to payers, maintaining compliance with federal, state and payer specific regulations
• Track and monitor application statuses, following up with payers and providers to resolve deficiencies or delays
• Ensure all processes and documentation comply with federal, state, and payer regulations
• Conduct internal audits of provider files and respond to audit requests from payers or regulators
• Assist in policy development and process improvements related to enrollment and credentialing
• Acts as a primary point of contact for escalated enrollment issues, collaborating with payers/IPAs, providers and internal departments (RCM, payer contract management, credentialing)
• Provide guidance and support to providers and administrative staff on credentialing best practices

Preferred Qualifications

• CPCS or CPMSM certification through NAMSS is a plus
• Experience with large group practices or multi-specialty providers
• Working knowledge of state and federal healthcare regulations
• May involve occasional travel for site visits or payer meetings

Benefits

• Flexible vacation, eligibility after 90-days
• 10 annual paid Holidays
• $500 annual education and development reimbursement
• Medical, Dental, Vision benefits, Life & additional supplemental coverage options
• 401K + Company Matching Program