Provider Enrollment & Medical Records Specialist
Position Summary The Provider Enrollment & Medical Records Specialist is responsible for managing provider credentialing and payer enrollment activities while ensuring timely and accurate retrieval, organization, and management of medical records. This role supports regulatory compliance, payer participation, and operational efficiency by maintaining accurate provider enrollment data and facilitating medical record requests and documentation workflows. The ideal candidate is detail-oriented, organized, and experienced in healthcare operations, with strong knowledge of provider enrollment processes, medical records management, and payer requirements.
Key Responsibilities
Provider Enrollment & Credentialing · Prepare, submit, and track provider enrollment applications for Medicare, Medicaid, and commercial payers. · Complete and maintain CAQH profiles and provider credentialing documentation. · Conduct live virtual identity proofing and 2FA passphrase setup for EPCS (Electronic Prescribing of Controlled Substances) activation — the federally mandated step for authorizing prescribers to prescribe controlled substances · Complete manual setting configurations in DrFirst and Atlas (signature requirements, pharmacy routing, default billing codes, notification preferences) · Manage Change of Vendor (COV) requests: extract provider data and submit support tickets to migrate prescribers from prior eRx vendors (e.g., DoseSpot) to DrFirst · Monitor application status and follow up with payers to ensure timely approval. · Maintain accurate records of provider enrollment status, expiration dates, and renewals. · Ensure compliance with payer and regulatory requirements related to provider enrollment. · Assist with onboarding and training of additional staff as team grows. · Proactively identify and surface opportunities to improve existing workflows Medical Records Management · Process and track medical record requests from payers, clients, auditors, and internal teams. · End-to-end submission of medical records to payers. · Retrieve medical records from providers as needed and coordinate with providers, clinical staff, and administrative teams to obtain necessary documentation. · Organize, review, and securely transmit medical documentation in accordance with HIPAA guidelines. · Maintain accurate documentation logs and record tracking systems. · Ensure records are complete and submitted within required timelines. Required Qualifications · High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred. · 5+ years of experience in provider enrollment, credentialing, medical records, and healthcare operations. · Working knowledge of Medicare, Medicaid, and commercial payer enrollment processes. · Experience with CAQH, PECOS, and ECPS required. · Experience with payer portals (Availity, UHC, Magellan, etc.) required · Experience with DrFirst, Google Sheets, Jira, Zoom, Slack preferred · Familiarity with HIPAA privacy and security regulations with high confidentiality and compliance awareness · Experience in high-volume, fast-paced operations environment a plus · Ability to work Monday thru Friday with hours between 10am to 7pm (exact schedule TBD) – Full-time 40 hours per week · Ability to start by 3/21/2026 Key Competencies · Highly organized and detail-oriented; methodical and SOP-driven with a sequential, detail-sensitive workflow with strong Time management and prioritization skills · Comfortable navigating multiple tools simultaneously (Jira, Atlas, Availity, payer portals, Google Sheets, Metabase dashboards) · Excellent verbal and written communication skills; comfortable leading structured live calls with licensed medical providers · Confidentiality and compliance awareness · Self-directed; available and responsive throughout scheduled shift without close supervision and ability to problem solve · Proactive learner; asks questions when something is unclear and picks up new workflows quickly Pay: $25.00 - $27.00 per hour Benefits:
- 401(k)
- Health insurance
- Paid time off
- Vision insurance
Work Location: Remote