Provider Enrollment Team Lead

Position Overview

• Location Type: Remote
• Employment Type: Full-time
• Salary: Not specified
• Circle Medical is a rapidly growing telemedicine provider with over 100% annual growth in the past three years. They are a venture-backed Y-Combinator healthcare startup focused on providing quality primary care to everyone.

Description

The Provider Enrollment Team Lead Specialist oversees the provider enrollment process, ensuring timely and accurate enrollment with government and commercial payers and IPAs. This role combines hands-on enrollment expertise with leadership responsibilities, guiding a team of enrollment specialists to meet departmental goals, maintain compliance, and optimize the reimbursement process. The team lead serves as a liaison between providers, payers, and internal departments, resolving complex issues and driving operational efficiency.

What You'll Do

• Team Leadership and Supervision:
  • Supervise, mentor, and train a team of provider enrollment specialists, fostering a collaborative and high-performing work environment.
  • Manage a team of specialists to ensure complete and submit credentialing applications, re-credentialing forms, and maintenance updates as required by payers.
  • Assign tasks, monitor team performance, and ensure adherence to deadlines and quality standards.
• Provider Enrollment Management:
  • Oversee the end-to-end provider enrollment process, including initial applications, re-enrollment, revalidation, and updates for providers.
  • Ensure accurate and timely submission of enrollment applications to payers, maintaining compliance with federal, state, and payer-specific regulations.
  • Track and monitor application statuses, following up with payers and providers to resolve deficiencies or delays.
• Compliance & Quality Assurance:
  • Ensure all processes and documentation comply with federal, state, and payer regulations.
  • Conduct internal audits of provider files and respond to audit requests from payers or regulators.
  • Assist in policy development and process improvements related to enrollment and credentialing.
• Process Improvement and Reporting:
  • Acts as a primary point of contact for escalated enrollment issues, collaborating with payers/IPAs, providers, and internal departments (RCM, payer contract management, credentialing).
  • Provide guidance and support to providers and administrative staff on credentialing best practices.

Qualifications

• Education & Experience:
  • Associate’s or Bachelor’s degree in healthcare administration, business, or a related field preferred.
  • Minimum 5 years of experience in provider enrollment, credentialing, or healthcare administration.
  • Familiarity with payer-specific requirements, CAQH, and NPI.