Provider Enrollment Specialist

About Sutherland

Sutherland is a global leader in driving business and digital transformation, and exceptional experiences along the entire journey of our clients engagement with their customers. With over 35 years of experience, we combine deep domain expertise and extensive knowledge in proven optimization with both proprietary and partnered tools and platforms to drive growth, efficiency, and productivity across organizations. Sutherland brings together our people, processes, products and platforms across cognitive artificial intelligence (AI), intelligent automation, advance analytics and digital services to create unique solutions for the industries that we service. The core values of remaining agile, outside-the-box thinking, uncompromising integrity and flawless execution are key pillars of the company. We serve marque brands across Healthcare, Insurance, Banking and Financial Services, Communications, Media and Entertainment, Technology, Travel and Logistics and Retail. Sutherland has 212 unique and independent inventions associated with several patent grants in critical technologies in the US and UK. Leveraging this IP and combining it with our platforms, domain expertise, engineering and digital expertise and collaborative partnerships, we are a team of 40,000 delivering tailored services and solutions driving tangible results at scale for our clients.

Position Summary

We are seeking a dedicated Provider Enrollment Specialist to join our revenue cycle team. This role is integral to ensuring healthcare providers, including physicians, clinics, and facilities, are successfully enrolled and credentialed with various government and commercial insurance payers. The specialist will facilitate timely reimbursement by confirming providers are actively participating in health plans and eligible to bill for services. This position requires serving as the primary liaison between providers, internal teams, and external payer organizations.

Essential Functions and Responsibilities

• Manage the preparation, submission, and tracking of initial enrollment applications and re-credentialing paperwork for all providers across diverse commercial and government payers like Medicare and Medicaid.
• Gather and meticulously verify all necessary documentation, such as licenses, DEA numbers, NPI numbers (Type 1 & 2), board certifications, malpractice insurance, and CVs, ensuring accuracy and up-to-date information.
• Act as the main point of contact for insurance plans, conducting consistent follow-ups via phone, email, and payer portals to monitor application status, resolve any discrepancies, and expedite the acquisition of provider numbers and effective dates.
• Accurately input and maintain all provider demographic and enrollment data within the credentialing database (e.g., CAQH, PECOS, internal systems) to uphold data integrity and compliance.
• Proactively troubleshoot and resolve complex enrollment-related issues, including claim denials stemming from credentialing problems and other discrepancies encountered during the enrollment process.
• Ensure all enrollment activities strictly adhere to state, federal (CMS), and organizational regulations (e.g., NCQA), and generate comprehensive status reports on application volume, approval rates, and processing timelines for management review.
• Identify potential bottlenecks or inefficiencies within the enrollment workflow and collaborate with management to implement process improvements and establish standard operating procedures (SOPs).

Additional Information

Notice Period: Immediate to 15 days.

Interested candidates are encouraged to submit their resumes to [email protected] or contact 7358785671.

Sutherland is committed to a fair hiring process and never requests payment or favors for job opportunities. Please report any suspicious activity immediately to [email protected].