PROVIDER ENROLLMENT SPECIALIST
USA Managed Care Organization
AustinEntry level1+ yrs
The job in short
Provider enrollment specialist.
MarketingInsuranceCompliance
Details
- Found
- 20 d ago · posted 2026-09-28
- Location as listed
- AUSTIN, TX, USA
- Role
- Medical Coding / Billing / Records
- Source
- The company’s own careers site
Full description
Job Details: Job Location: USA Managed Care Organization Austin - AUSTIN, TX, Position Type: Full Time, Education Level: High School, Salary Range: Undisclosed, Job Shift: Day, Job Category: Admin - Clerical, Job Summary
The Provider Enrollment Specialist is responsible for building and expanding PPO and specialty healthcare networks for a national managed care organization. This role includes initiating provider outreach, conducting presentations, negotiating reimbursement rates, and finalizing contracts with individual providers, ancillary facilities, and hospitals. The Specialist collaborates with internal stakeholders to identify market opportunities and develop strategic plans to enhance network adequacy and meet client needs.
Essential Duties and Responsibilities
Align activities with the company’s mission, objectives, and operational strategy.
Utilize contracting methodologies to build and maintain provider relationships.
Initiate discussions and negotiations with healthcare providers to secure contracts and reimbursement schedules.
Finalize agreements, amendments, and addenda with various provider types.
Work closely with the VP of Network Development and marketing/contracting teams to ensure network adequacy.
Renegotiate reimbursement rates with existing contracted providers as necessary.
Process and review provider applications to ensure credentialing documentation is accurate and complete.
Respond promptly to provider status inquiries via phone and email.
Maintain accurate tracking of productivity and contract progress.
Adhere to the organization’s Information Security Policies and HIPAA compliance standards.
Qualifications
Minimum of 1 year of experience negotiating provider reimbursement rates (preferred, not required).
Familiarity with CPT coding, Medicare RBRVS, ASC groupers, and per diem rate structures (preferred).
Basic understanding of medical terminology (preferred).
Strong verbal and written communication skills.
Excellent organizational and time management skills.
Professional appearance and demeanor.
Physical Requirements
Must be able to operate standard office equipment (computer, telephone, copier, etc.).
Ability to sit or stand for prolonged periods throughout the workday.
Frequent computer/keyboard use (over ⅔ of the day).
Visual acuity requirements include close vision, distance vision, and the ability to adjust focus.
Frequent verbal communication and listening throughout the day.
Benefits:
401(k)
401(k) matching
AD&D insurance
Dental insurance
Disability insurance
Employee assistance program
Flexible spending account
Paid Sick Time
Health insurance
Life insurance
Paid time off
Parental leave
Referral program
Retirement plan
Tuition reimbursement
Vision insurance
Job Type: Full-time
Shift availability:
Day Shift (Required)
Ability to Commute:
West Lake Hls, TX 78746 (Required)
Work Location: In person
Qualifications:
Medical Coding / Billing / Records jobs in Austin, Texas · Medical Coding / Billing / Records jobs in the United States · All USA Managed Care Organization jobs · Entry-level jobs in Austin, Texas