Job Summary
Coordinates employed and contracted billable provider's and facilities initial enrollment and re-credentialing process with third party payers, out of state Medicaid and Medicare. Includes NPI management for facilities. Maintains database for hospital, group and billing providers and provides reports as requested. Research claim denials related to provider enrollment/credentialing issues. Build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Assist with the full range of provider relations and service interactions, including working on end-to-end provider claim and call quality and training and development of external provider education programs.
Responsibilities*
- Prepare, submit, and track initial, update, revalidation, and termination applications for professional and facility providers across all assigned government and commercial payors.
- Maintain accurate data in internal systems (e.g., Cactus, PECOS, CHAMPS, CAQH, Availity, or payor portals and other credentialling systems).
- Ensure alignment between enrollment, credentialing, and billing records (NPI, TIN, taxonomy, specialty, and group affiliations).
- Collaborate with billing and other Revenue Cycle staff to resolve claim denials or delayed payments due to enrollment issues.
- Monitor and manage EPIC Provider Enrollment WQs by identifying and resolving issues.
- Coordinate enrollment for Out-of-State Medicaid, Workers? Compensation, Tricare, and other non-standard payors as applicable.
- Manage delegated and direct entry enrollment agreements, adhering to each contract?s service level standards and reporting requirements.
- Ensure compliance with CMS, state Medicaid, NCQA, and commercial payor requirements for provider enrollment.
- Maintain audit-ready documentation, supporting enrollment verification for credentialing, compliance, and revenue cycle audits.
- Identify discrepancies or risk areas and escalate them to the Enrollment Manager or Compliance Officer.
- Protect sensitive provider data in accordance with HIPAA and organizational privacy standards.
- Communicate enrollment progress and issues clearly to stakeholders and providers.
- Collaborate with credentialing staff to align recredentialing cycles with revalidation requirements.
- Participate in continuous improvement initiatives, contributing to process documentation, workflow optimization, and automation efforts.
- Assist in developing and maintaining policies, procedures, and training materials for the enrollment function.
- Perform other duties or special projects related to Provider Enrollment as assigned
- Attention to Detail: Ensures data accuracy across multiple systems.
- Communication: Provides clear, professional, and timely updates to internal and external partners.
Required Qualifications*
- Experience: Minimum 2 years of experience in Revenue Cycle, Provider Enrollment, Credentialing, or Billing
Desired Qualifications*
- Education: Bachelor's degree in business, healthcare administration, or related field
- Familiarity with systems such as CAQH, PECOS, CHAMPS, Availity, NPPES, and payor-specific portals.
- Healthcare facility and professional billing experience
- Knowledge of delegated credentialing processes, payor contract structures, and CMS enrollment regulations.
- Knowledge of claims reimbursement processes
- Skills: Intermediate Excel and data tracking/reporting ability; excellent written and verbal communication skills; strong organizational and prioritization abilities.
- Strong analytical, problem-solving, and organizational skills
- Proficiency in Microsoft Office applications
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.
Union Affiliation
This position is covered under the collective bargaining agreement between the U-M and the Service Employees International Union (SEIU), which contains and settles all matters with respect to wages, benefits, hours, and other terms and conditions of employment.
Background Screening
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Application Deadline
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO Statement
The University of Michigan is an equal employment opportunity employer.