Explore jobs
Find specific jobs
Explore careers
Explore professions
Best companies
Explore companies
What is a provider enrollment specialist and how to become one
As a provider enrollment specialist, your primary concern is to handle application procedures in your company or healthcare facility. In doing so, you are also responsible for ensuring adherence to HIPAA guidelines (and other relevant laws and regulations) and the security of private information.
The duties for this role revolve around gathering client information, reviewing applications, verifying relevant documents, processing applications, and working with clients about their concerns. Moreover, this job also includes tasks like updating databases, educating clients about policies and regulations, and assisting eligible recipients of medical insurance coverage.
If you have a degree in business or healthcare administration or something similar, you are one step closer to becoming a provider enrollment specialist. Some employers require experience apart from a degree, but it may not always be necessary. Similarly, you can qualify for the role of a provider enrollment specialist with a high school diploma as long as you have relevant work experience.
When it comes to salary, the average pay for this job is $39,000 per year or around $19 an hour.
Avg. Salary $39,494
Avg. Salary $59,228
Growth rate 7%
Growth rate 0.3%
American Indian and Alaska Native 0.34%
Asian 7.53%
Black or African American 12.54%
Hispanic or Latino 15.59%
Unknown 3.63%
White 60.39%
Genderfemale 80.36%
male 19.64%
Age - 45American Indian and Alaska Native 3.00%
Asian 7.00%
Black or African American 14.00%
Hispanic or Latino 19.00%
White 57.00%
Genderfemale 47.00%
male 53.00%
Age - 45Stress level is manageable
7.1 - high
Complexity level is challenging
7 - challenging
Work life balance is fair
6.4 - fair
Provider enrollment specialist career paths
Key steps to become a provider enrollment specialist
Explore provider enrollment specialist education requirements
Start to develop specific provider enrollment specialist skills
Skills Percentages Data Entry 12.44% Patients 12.19% CAQH 8.67% Medicare 6.98% Medicaid 6.98% Complete relevant provider enrollment specialist training and internships
Accountants spend an average of 6-12 months on post-employment, on-the-job training. New provider enrollment specialists learn the skills and techniques required for their job and employer during this time. The chart below shows how long it takes to gain competency as a provider enrollment specialist based on U.S. Bureau of Labor Statistics data and data from real provider enrollment specialist resumes.Gain additional provider enrollment specialist certifications
More About CertificationsProvider enrollment specialist certifications can show employers you have a baseline of knowledge expected for the position. Certifications can also make you a more competitive candidate. Even if employers don't require a specific provider enrollment specialist certification, having one may help you stand out relative to other applicants.
The most common certifications for provider enrollment specialists include Certified Billing and Coding Specialist (CBCS) and Certified Nurse Assistant (CNA).
Research provider enrollment specialist duties and responsibilities
- Manage federal and state-mandate physician credentialing activities; act as NCQA committee liaison.
- Provide enrollment counseling to eligible recipients about Medicaid manage care and promote their voluntary enrollment into an HMO.
- Review provider enrollment applications to ensure the credentials and licenses meet all requirements for participation in the Medicare program.
- Verify provider is eligible to participate in Medicare according to CMS guidelines.
Prepare your provider enrollment specialist resume
When your background is strong enough, you can start writing your provider enrollment specialist resume.
You can use Zippia's AI resume builder to make the resume writing process easier while also making sure that you include key information that hiring managers expect to see on a provider enrollment specialist resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.
Choose from 10+ customizable provider enrollment specialist resume templates
Build a professional provider enrollment specialist resume in minutes. Browse through our resume examples to identify the best way to word your resume. Then choose from 10+ resume templates to create your provider enrollment specialist resume.
Apply for provider enrollment specialist jobs
Now it's time to start searching for a provider enrollment specialist job. Consider the tips below for a successful job search:
- Browse job boards for relevant postings
- Consult your professional network
- Reach out to companies you're interested in working for directly
- Watch out for job scams
How did you land your first provider enrollment specialist job
Are you a provider enrollment specialist?
Share your story for a free salary report.
Average provider enrollment specialist salary
The average provider enrollment specialist salary in the United States is $39,494 per year or $19 per hour. Provider enrollment specialist salaries range between $28,000 and $54,000 per year.
What am I worth?
How do provider enrollment specialists rate their job?
Updated January 8, 2025
