Provider Enrollment Analyst

Mdvip•Boca Raton, FL

1d•Onsite

About The Position

MDVIP is seeking a Provider Enrollment Analyst, reporting to the Manager of Insurance Programs, to manage the insurance provider enrollment process for our MDVIP physician affiliates. This role requires a deep understanding of credentialing & contracting procedures and the ability to provide accurate guidance and support to affiliated physicians, physician staff and internal teams. If you have a thorough understanding of managing provider enrollment and are a critical thinker, we want to meet you. You’ll coordinate with and support the Insurance Services Department in the resolution of complex or advanced issues and cases. As the Provider Enrollment Analyst, you’ll serve as a liaison between MDVIP and insurance carriers, commercial and federal clearinghouses, and regulatory bodies at the state, county, and federal levels. Additionally, you will ensure compliance with all licensing and credentialing requirements on behalf of MDVIP affiliated physicians.

Requirements

Associate’s degree and at least two (2) years related business experience
Four (4) years of related work experience.
Familiarity with EMR and credentialing software.
Proficient in Microsoft Office applications.
Successful track record in a similar corporate role focused on coordination or management of provider enrollment.
Interprets complex data using experience and critical thinking to support insights.
Builds collaborative, productive relationships with physicians , physician staff and stakeholders.
Communicates clearly, professionally, and effectively across diverse audiences.
Proactively identifies solutions, pursues growth, and seeks added responsibility.
Demonstrates accountability, meets deadlines, and maintains daily preparedness.
Applies strategic thinking to assess risks, trends, and opportunities for informed decision-making.

Nice To Haves

Experience with CAQH, PECOS & NPPES applications.
Experience with Net Docs, credentialing software, and athena.
Certified Provider Credentialing Specialist (CPCS).
Certified Provider Enrollment Specialist (CPES).
Experience with Salesforce or other CRM tools.

Responsibilities

Manages non-standard provider enrollment workflows, interpreting payer-specific contract requirements and independently navigating complex scenarios that fall outside templated enrollment processes.
Accountable for end ‑ to ‑ end provider enrollment and contracting coordination through completion, delivering responsive, high ‑ quality service while proactively educating physicians on timelines, managing expectations, and maintaining strong partnerships as operational challenges arise.
Serves as the primary liaison and subject ‑ matter expert for provider enrollment, collaborating across physicians, internal stakeholders, and external partners to drive alignment, quality, operational readiness, and a consistently high standard of service across credentialing and contracting workflows.
Complete statewide credentialing applications to establish new groups and add providers to commercial payers and Medicare
Serves as the authoritative steward of provider enrollment data.
Conducts detailed analysis and reconciliation of provider enrollment information across multiple systems, proactively identifying discrepancies, downstream risks, and potential impacts to revenue, access, or compliance.
Maintain provider enrollment system processes, policy and procedures, ensuring adherence to all requirements and taking corrective steps as needed.
Exercises independent judgment to resolve enrollment obstacles and exceptions, escalating only high-risk, systemic, or time-sensitive issues with clearly defined solution options and impact assessments.
Maintains operational and regulatory integrity of provider enrollment data by independently managing, validating, and reconciling complex provider records across high-volume, payer-specific enrollment workflows.
Provide training and guidance to affiliates, physician staff or respective billing companies related to MDVIP, when requested, on preventive billing protocols and/or provider enrollment needs.
Develop, analyze, and distribute timely status reports to affiliated physicians and field staff; proactively manage follow-ups to ensure resolution and closure of all outstanding cases.
Compile, validate, and deliver comprehensive insurance related reports and management presentations, translating complex data into clear insights to support decision making and operational planning.
Conducts detailed analysis and reconciliation of provider enrollment data to support accurate contracting, payer submissions, and ongoing network compliance, while managing complex, non-standard enrollment scenarios.
Independently identifies, evaluates, and synthesizes complex enrollment and contracting issues, delivering clear root-cause analysis and actionable recommendations to management.
Resolves escalated issues and urgent requests.