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Provider Enrollment Specialist Jobs (NOW HIRING)

XIFIN

Provider Enrollment Specialist

Charleston, SC · On-site

$23 - $29/hr

Provider Enrollment Specialist Are you interested in harnessing technology and AI to transform healthcare? At XiFin , we believe a healthier, more efficient healthcare system starts with strong ...

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How much do provider enrollment specialist jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for provider enrollment specialist in the United States is $23.04, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $24.76 per hour, depending on experience, location, and employer.

What is a provider enrollment specialist?

Provider Enrollment Specialists are professionals who handle the process of enrolling healthcare providers with insurance companies, Medicare, and Medicaid. They ensure that providers are properly credentialed and authorized to deliver services and receive reimbursements from payers. Their responsibilities include completing applications, verifying credentials, tracking enrollment status, and maintaining accurate records. These specialists play a critical role in making sure healthcare organizations can offer services and receive payment efficiently.

What does a provider enrollment specialist do?

A provider enrollment specialist works at a doctor’s office or medical facility, such as a hospital, and is responsible for determining whether or not a patient is eligible for health care services. As a provider enrollment specialist, you have the skills and qualifications required to evaluate customer insurance to determine possible treatment options. Your other duties include making suggestions for different treatment programs based on the patient’s insurance coverage and obtaining patient records. To succeed in this career, you need job experience in a health care setting and knowledge of medical terminology. Some employers may require advanced education or nursing certification.

What are the key skills and qualifications needed to thrive as a provider enrollment specialist, and why are they important?

To thrive as a Provider Enrollment Specialist, you need a thorough understanding of healthcare regulations, credentialing processes, and insurance requirements, often supported by experience in healthcare administration or related certifications. Familiarity with provider enrollment software, credentialing databases, and systems like CAQH and Medicare/Medicaid portals is essential. Attention to detail, strong organizational skills, and effective communication are critical soft skills for managing complex documentation and coordinating with providers and payers. These abilities ensure timely and accurate provider onboarding, compliance with regulations, and efficient reimbursement processes.

What are some common challenges faced by provider enrollment specialists when working with healthcare payers?

Provider Enrollment Specialists often encounter challenges such as navigating varying requirements and documentation standards among different healthcare payers, which can lead to delays in processing enrollments. Keeping up with frequent regulatory updates and payer-specific policy changes also requires close attention to detail and ongoing education. Additionally, coordinating between providers, credentialing teams, and insurance companies to resolve discrepancies or incomplete applications is a common part of the role, requiring strong communication and problem-solving skills.

What is the difference between Provider Enrollment Specialist vs Billing Specialist?

AspectProvider Enrollment SpecialistBilling Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires billing or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, government agenciesMedical offices, hospitals, billing companies
Employer & IndustryHealthcare providers, insurance companies, government programsMedical practices, hospitals, billing firms
Search & Comparison IntentUnderstanding roles related to provider credentialing and enrollmentUnderstanding medical billing and reimbursement processes

The Provider Enrollment Specialist focuses on enrolling healthcare providers with insurance plans and government programs, ensuring compliance and credentialing. In contrast, a Billing Specialist handles medical billing, coding, and reimbursement processes. While both roles support healthcare operations, they differ in responsibilities, certifications, and daily tasks.

How do you become a provider enrollment specialist?

To become a provider enrollment specialist, candidates typically need a high school diploma or equivalent, along with experience in healthcare administration or insurance billing. Familiarity with provider enrollment processes, knowledge of healthcare regulations, and proficiency with enrollment systems like PECOS or CAQH are also important. Some roles may require certification or training in healthcare compliance or billing procedures.
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Provider Enrollment Specialist jobs near you
Infographic showing various Provider Enrollment Specialist job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 76% Full Time, 15% Part Time, and 6% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $47,922 per year, or $23 per hour.

Provider Enrollment Specialist

American Advanced Management

Salida, CA • On-site

$22 - $26/hr

Other

Re-posted 27 days ago

Job description

The Provider Enrollment Specialist role involves managing the administrative process of getting healthcare providers credentialed with insurance companies and government payers like Medicare and Medicaid. Key duties include preparing and submitting applications, tracking their status, maintaining accurate provider records, ensuring compliance with regulations, and following up with providers and payers to resolve issues.
JOB DUTIES

  • Prepare and submit enrollment applications and supporting documents for new and existing providers.
  • Maintain and update provider information in databases and systems, ensuring accuracy of details like licenses, certifications, and addresses.
  • Verify provider credentials and ensure all paperwork meets the requirements of various health plans and government payers.
  • Act as a liaison by responding to inquiries from providers and payers, and follow up to expedite the enrollment and re-enrollment process.
  • Research and resolve issues that delay enrollment, such as missing information on applications.
  • Organize and maintain files for all provider enrollments and other related documentation.

Requirements
The Provider Enrollment Specialist will possess a strong understanding of healthcare regulations, payer requirements, and provider enrollment processes, along with familiarity with medical terminology and basic billing practices. Technical proficiency is essential, including experience with provider enrollment software, credentialing databases such as CAQH, and common office applications like Word and Excel. Success in this role requires excellent attention to detail, strong organizational skills, and effective communication to manage complex documentation and coordinate with multiple stakeholders. Prior experience in a healthcare setting with at least three (3) to five (5) years of experience is preferred, particularly in credentialing, managed care, or claims processing.
Salary Description
$22.00 -$26.00

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