Provider Enrollment Coordinator

About the role

Build your Career. Make a Difference. Presbyterian is hiring a skilled Provider Enrollment Coordinator. Processes payer enrollment applications for all PHS‑employed or contracted healthcare providers. Supports the Provider Enrollment Manager in directing the system‑wide enrollment process to ensure all responsible providers are billable. Prepares, submits, and tracks enrollment applications with contracted health plans, maintaining communication with providers throughout the process. Generates applications, gathers required documents, secures signatures, and submits completed packets to payers. Obtains and distributes PINs/enrollment numbers to billing offices. Maintains strong working relationships with Medical Staff Affairs, Credentialing, Business Office, Contracting, PMG, regional administrators, and external agencies to support timely enrollment and maximize revenue. Type of Opportunity: Full time Job Exempt: No Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America)

Responsibilities

• Processes all provider changes (e.g., pointage, specialty, function, terminations) and completes required payer applications. Performs audits using Cactus reports, risk management term reports, payer reports, and internal file reviews.
• Manages monthly updates and uploads of the Provider Directory, credentialing grid, and new‑provider status reports. Assists in training new staff and contributes to developing and revising departmental policies, procedures, criteria, audit tools, and desktop manuals.
• Conducts denial management for assigned providers, reviewing write‑off and denial reports, escalating issues as needed, and following up on outstanding claims. Handles purging and preparation of termed provider files for scanning.
• Investigates and resolves customer complaints from EWC related to assigned providers. Serves as departmental representative and point of contact for contracted payer meetings.

Requirements

• Associates Degree preferred or at least three years of experience in a medical, business or medical staff affairs office required.
• Possess strong interpersonal skills and able to relate positively to health care providers.
• Possess basic computer skills including use of Windows, MS Office and Outlook.
• Claims processing and medical terminology experience a plus
• Essential Education : High school diploma
• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Wellness
• Why work at Presbyterian?
• As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
• About Presbyterian Healthcare Services
• Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
• AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
• We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

Benefits

Additional Information

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $16.79 Maximum Offer $24.95 Now Hiring: Provider Enrollment Coordinator

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