Provider Enrollment and Network Mgmt Specialist

The Provider Enrollment & Network Management Specialist is responsible for coordinating organizational payer enrollments, site and service additions, network participation, directory maintenance, and payer implementation activities. This position serves as the primary liaison between Easterseals PORT Health and Commercial, Medicare, Medicaid, and Managed Care Organization (MCO) payers to ensure timely implementation and maintenance of organizational sites and services.

• Coordinate and manage organizational site and service enrollments with Commercial, Medicare, Medicaid, and Managed Care Organization (MCO) payers.
• Prepare, submit, and track applications and supporting documentation required for new site, service, and program implementations.
• Monitor enrollment status and conduct follow-up with payer representatives to ensure timely processing and implementation.
• Coordinate site relocations, closures, service modifications, and organizational demographic changes with payers.
• Assist with implementation of newly executed payer contracts by coordinating site and service participation with applicable payers and communicating updates to internal stakeholders.
• Serve as the primary administrative contact for payer communications related to site and service participation.
• Maintain payer directory accuracy and coordinate resolution of directory discrepancies.

• Collaborate with Operations, Credentialing, Revenue Cycle Management, Quality Management, and program leadership regarding enrollment and implementation activities.
• Support Electronic Health Record (EHR) improvement initiatives and payer incentive programs.
• Maintain enrollment tracking logs, databases, and supporting documentation.
• Prepare reports and provide regular status updates to leadership regarding enrollment and implementation activities.
• Ensure the accuracy and completeness of enrollment records and related documentation.

• Performs other duties as assigned, including driving as required for the position.

• Associate's Degree in Healthcare Administration, Business Administration, or related field; or equivalent combination of education and experience.
• Three (3) years of experience in provider enrollment, managed care operations, credentialing support, healthcare administration, or related functions.
• Knowledge of payer enrollment and network participation processes.
• Strong organizational, project management, and problem-solving skills.
• Ability to manage multiple priorities and deadlines.
• Strong attention to detail and follow-through.
• Excellent verbal and written communication skills.
• Ability to work collaboratively across departments.
• Proficiency in Microsoft Office Suite, including Excel, Outlook, Word, SharePoint, and Teams.
• Ability to maintain confidential and sensitive information.

• Experience working with Medicare, Medicaid, Commercial, and Managed Care Organization payers.
• Experience in Behavioral Health, Intellectual and Developmental Disabilities (I/DD), and Substance Use Disorder (SUD) services.

Essential physical requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The qualifications listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Must possess the necessary abilities to perform tasks such as develop written communication as well as reviewing work to determine accuracy.
• Ability to communicate effectively with internal and external clients, and being able to remain in a stationary position for extended periods of time.

Why Join Us?  

As a part of our mission, we help our team members embrace their potential, build resilience, and thrive! You will benefit from ongoing professional growth and development as you work alongside leaders of clinical excellence in mental health and substance use services that care about your success. 

We also offer a full benefits package for benefits-eligible positions.