How to hire a provider enrollment specialist

How to hire a provider enrollment specialist, step by step

Here's a step-by-step provider enrollment specialist hiring guide:

• Step 1: Identify your hiring needs
• Step 2: Create an ideal candidate profile
• Step 3: Make a budget
• Step 4: Write a provider enrollment specialist job description
• Step 5: Post your job
• Step 6: Interview candidates
• Step 7: Send a job offer and onboard your new provider enrollment specialist
• Step 8: Go through the hiring process checklist

What does a provider enrollment specialist do?

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1. Identify your hiring needs

   Before you start hiring a provider enrollment specialist, identify what type of worker you actually need. Certain positions might call for a full-time employee, while others can be done by a part-time worker or contractor.

   Determine employee vs contractor status

   Is the person you're thinking of hiring a US citizen or green card holder?

   Yes

   No

   A provider enrollment specialist's background is also an important factor in determining whether they'll be a good fit for the position. For example, provider enrollment specialists from different industries or fields will have radically different experiences and will bring different viewpoints to the role. You also need to consider the candidate's previous level of experience to make sure they'll be comfortable with the job's level of seniority.

   Here's a comparison of provider enrollment specialist salaries for various roles:

   Type of Provider Enrollment Specialist	Description	Hourly rate
   Provider Enrollment Specialist	Compensation, benefits, and job analysis specialists conduct an organization’s compensation and benefits programs. They also evaluate position descriptions to determine details such as a person’s classification and salary.	$13-25
   Benefits Advisor	A benefits advisor specializes in devising benefits programs and strategies for a workforce, ensuring they are well-compensated for their hard work. Typically, their responsibilities revolve around performing research and analysis to identify the needs of employees in a company, studying the benefit programs of competitors, and assessing the existing programs while putting the company's welfare into consideration... Show more	$22-52
   Employee Benefits Supervisor	An Employee Benefits Supervisor supervises, trains, and completes performance reviews for the staff they manage. They develop and update procedure manuals, analyze, note down company operations, and interact with company vendors, staff, officials, members, and other entities... Show more	$15-37

   Show more

2. Create an ideal candidate profile

   Common skills:

   • Data Entry
   • Patients
   • CAQH
   • Medicare
   • Medicaid
   • Provider Enrollment Applications
   • CMS
   • HIPAA
   • Provider Enrollment
   • Medicare Program
   • Insurance Carriers
   • DEA
   • Quality Standards
   • NPI

   Check all skills

   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.
   • Verify claim information using ICD-9 and medical terminology and CHAMPUS/ TRICARE guidelines .!
   • Complete require forms and application for changes or updates in billing systems including EFT and or notification of Athena.

   More provider enrollment specialist duties

3. Make a budget

   Including a salary range in your provider enrollment specialist job description helps attract top candidates to the position. A provider enrollment specialist salary can be affected by several factors, such as geography, experience, seniority, certifications, and the prestige of the hiring company.

   For example, the average salary for a provider enrollment specialist in West Virginia may be lower than in Alaska, and an entry-level provider enrollment specialist usually earns less than a senior-level provider enrollment specialist. Additionally, a provider enrollment specialist with certifications may command a higher salary, and working for a well-known company or start-up may also impact an employee's pay.

   Average provider enrollment specialist salary

   $39,494yearly

   $18.99 hourly rate

   ---

   Entry-level provider enrollment specialist salary

   $28,000 yearly salary

   Updated December 16, 2025

   Average provider enrollment specialist salary by state

   Rank	State	Avg. salary	Hourly rate
   1	California	$50,482	$24
   2	Washington	$46,234	$22
   3	New York	$44,322	$21
   4	Mississippi	$43,204	$21
   5	Pennsylvania	$41,882	$20
   6	Virginia	$41,626	$20
   7	Connecticut	$41,158	$20
   8	Nevada	$40,890	$20
   9	Texas	$40,162	$19
   10	New Hampshire	$40,066	$19
   11	Michigan	$39,814	$19
   12	North Dakota	$38,745	$19
   13	Iowa	$38,729	$19
   14	Georgia	$37,914	$18
   15	North Carolina	$36,568	$18
   16	Kansas	$35,664	$17
   17	Missouri	$35,181	$17
   18	Louisiana	$35,069	$17
   19	Alabama	$33,924	$16
   20	Tennessee	$33,452	$16

   Average provider enrollment specialist salary by company

   Company

   Rank	Company	Average salary	Hourly rate	Job openings
   1	McKinsey & Company Inc	$70,754	$34.02	38
   2	Shriners Hospitals for Children	$60,156	$28.92
   3	Mount Sinai Health System	$59,562	$28.64	2
   4	The reThink Group	$57,533	$27.66
   5	Sound Physicians	$48,081	$23.12
   6	Delta Dental of NM	$47,003	$22.60
   7	Delta Dental Ins	$44,717	$21.50	1
   8	White Plains Hospital	$43,078	$20.71	2
   9	Clarivate	$42,534	$20.45
   10	Beth Israel Lahey Health	$42,368	$20.37	14
   11	SteadyMD	$42,368	$20.37
   12	Privia Health	$42,318	$20.35	2
   13	P3 HealthCare Solutions	$42,176	$20.28
   14	NYU Lutheran Medical Center	$41,922	$20.15	1
   15	Alignment Healthcare	$41,779	$20.09	7
   16	Delta Dental of Minnesota	$41,411	$19.91
   17	AmeriHealth Caritas	$41,361	$19.89	2
   18	DentaQuest	$40,961	$19.69	1
   19	EnableComp	$40,508	$19.48	2
   20	Advanced Dermatology Associates	$40,470	$19.46

4. Writing a provider enrollment specialist job description

   A provider enrollment specialist job description should include a summary of the role, required skills, and a list of responsibilities. It's also good to include a salary range and the first name of the hiring manager. To help get you started, here's an example of a provider enrollment specialist job description:

   Provider enrollment specialist job description example

   major purpose This position is a critical in processing health care provider’ s enrollment applications and provider updates. This process includes the verification of provider credentials through various government agencies and license boards, reviewing the accuracy of provider demographic and billing information within the EOHHS MMIS system, communicating with providers to clarify or obtain missing information or documents, and various data entry functions. essential job duties
   
   Research, verify, and document provider credentialing information through various government agencies and license boards as part of provider enrollment regulations
   
   Contact providers either by phone or email to clarify or obtain missing documents from the provider application submission
   
   Communicate with providers or office staff and walk them through the application and update process and requirements
   Document communication notes and resolution outcomes Review the application and update submission in its entirety and confirm that all data is accurate and all revalidation documents are completed and uploaded. Also check that all verification documents are complete and uploaded Respond to inquiries on the status of application and update submissions for various providers and support the department' s administrative requirements including preparing educational documents and supporting other reporting needs education requirements
   The ideal candidate must have
   High school diploma or equivalent.
   education Preferred
   Associate' s degree from an accredited college or university. Two to three years of equivalent experience will be considered in lieu of degree.
   Required KSAs
   At least two (2) years of relevant experience required Knowledge of provider credentialing standards and requirements Track record of accomplishments and ability to document communication and outcomes effectively Excellent organizational, communication and interpersonal skills Strong customer service experience, preferably in a provider services call center or credentialing department Ability to perform comfortably in a fast-paced, deadline-oriented work environment Proficient in Microsoft Office (PowerPoint, Word, Excel and Outlook) Ability to work as a team member as well as independently Ability to successfully execute many complex tasks simultaneously preferred ksas Experience in a health care environment Understanding of provider billing practices and claim processing is preferred Physical Requirements Must be able to remain in a stationary position for an extended period of time Additional Notes This position is a critical in processing health care provider’ s enrollment applications and provider updates. This process includes the verification of provider credentials through various government agencies and license boards, reviewing the accuracy of provider demographic and billing information within the EOHHS MMIS system, communicating with providers to clarify or obtain missing information or documents, and various data entry functions.

   Copy this example

   

5. Post your job

   There are various strategies that you can use to find the right provider enrollment specialist for your business:

   • Consider promoting from within or recruiting from your existing workforce.
   • Ask for referrals from friends, family members, and current employees.
   • Attend job fairs at local colleges to find candidates who meet your education requirements.
   • Use social media platforms like LinkedIn, Facebook, and Twitter to reach potential job candidates.

   Post your job online:

   • Post your provider enrollment specialist job on Zippia to find and recruit provider enrollment specialist candidates who meet your exact specifications.
   • Use field-specific websites.
   • Post a job on free websites.

6. Interview candidates

   To successfully recruit provider enrollment specialists, your first interview needs to engage with candidates to learn about their interest in the role and experience in the field. You can go into more detail about the company, the role, and the responsibilities during follow-up interviews.

   Remember to include a few questions that allow candidates to expand on their strengths in their own words. Asking about their unique skills might reveal things you'd miss otherwise. At this point, good candidates can move on to the technical interview.

   The right interview questions can help you assess a candidate's hard skills, behavioral intelligence, and soft skills.

7. Send a job offer and onboard your new provider enrollment specialist

   Once you've selected the best provider enrollment specialist candidate for the job, it's time to write an offer letter. In addition to salary, this letter should include details about the benefits and perks you offer the candidate. Ensuring that your offer is competitive is essential, as qualified candidates may be considering other job opportunities. The candidate may wish to negotiate the terms of the offer, and you should be open to discussion. After you reach an agreement, the final step is formalizing the agreement with a contract.

   It's also important to follow up with applicants who do not get the job with an email letting them know that the position is filled.

   After that, you can create an onboarding schedule for a new provider enrollment specialist. Human Resources and the hiring manager should complete Employee Action Forms. Human Resources should also ensure that onboarding paperwork is completed, including I-9s, benefits enrollment, federal and state tax forms, etc., and that new employee files are created.

8. Go through the hiring process checklist

   • Determine employee type (full-time, part-time, contractor, etc.)
   • Submit a job requisition form to the HR department
   • Define job responsibilities and requirements
   • Establish budget and timeline
   • Determine hiring decision makers for the role
   • Write job description
   • Post job on job boards, company website, etc.
   • Promote the job internally
   • Process applications through applicant tracking system
   • Review resumes and cover letters
   • Shortlist candidates for screening
   • Hold phone/virtual interview screening with first round of candidates
   • Conduct in-person interviews with top candidates from first round
   • Score candidates based on weighted criteria (e.g., experience, education, background, cultural fit, skill set, etc.)
   • Conduct background checks on top candidates
   • Check references of top candidates
   • Consult with HR and hiring decision makers on job offer specifics
   • Extend offer to top candidate(s)
   • Receive formal job offer acceptance and signed employment contract
   • Inform other candidates that the position has been filled
   • Set and communicate onboarding schedule to new hire(s)
   • Complete new hire paperwork (i9, benefits enrollment, tax forms, etc.)

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