Provider Enrollment Specialist II

At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.

Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.

Payer Enrollment & RCM‑Aligned Responsibilities

• Manage and coordinate all aspects of payer enrollment for new and existing providers, including tracking progress, deadlines, and payer requirements.

• Verify group‑level versus provider‑level contracts to confirm enrollment steps required by each payer.

• Complete andsubmitpayer enrollment applications (including signature‑required forms) and perform proactive follow‑up toexpediteapprovals.

• Utilize payer portals tosubmitinformation, track status, manage rosters, and complete provider demographic updates, location changes, and revalidations.

• Utilize Athena practice management toidentifyenrollment issues, and complete tasks related to provider configuration.

• Communicate provider changes to contracted health plans and FCS, AMGR, and AMGBA management via standardized reports.

Government Payer Maintenance (CMS / DHCS)

• Manage Medicare revalidation cycles andsubmitupdates through PECOS.

• Perform annual Medi‑Cal renewals andmaintainrecords in PAVE.

EHR & System Collaboration

• Work within the EHR/practice management system (Athena) toidentify, troubleshoot, and resolve enrollment‑related issues.

• Collaborate with IT/EHR analysts, Revenue Cycle, and Operations to correct provider setup, payer participation mapping, NPI/taxonomy assignments, and other configuration componentsrequiredfor clean claim submission.

• Independently troubleshoot complex EHR enrollment errors to prevent billing delays.

Credentialing & Recredentialing

• Responsible for all aspects of credentialing/recredentialing providers, including verification of applications and documents, mailing of requests for consideration, preparing initial applications, issuing approval/denial/termination letters, and accurately loading provider information in credentialing databases.

• Process credentialing and recredentialing applications accurately and promptlyin accordance withFCS, AMGR, and AMGBA policies, health plan delegation requirements, and NCQA standards.

• Perform credentialing for health plans, hospital medical staff, and surgery centers.

• Track andmaintainrenewal‑based provider credentials, including licenses, DEA registrations, board certifications, malpractice coverage, and other compliance documents.

• Disseminate new ormodifiedprofessional information to FCS, AMGR, and AMGBA providers and departments.

• Coordinate credentialing and recredentialing task grids and tickler systems to ensure follow‑up andtimelycompletion.

Data Management, Compliance & Audits

• Responsible foraccurateinput, updates, and modifications to the credentialing database; perform routine audits toassureaccuracy.

• Review state and federalsanctionsbulletins and update provider files accordingly.

• Prepare materials for external audits by payors and governmental agencies; ensure filesremainaudit‑ready.

• Maintain up‑to‑date records across internal databases, CAQH, PECOS, PAVE, payer portals, and contract files.

Administrative Coordination & Communication

• Coordinate responses to payer inquiries; follow up with payers and providers to completion.

• Maintain effective communication with health plan representatives and AMG departments.

• Participate in training sessions related to payer enrollment and credentialing workflows; collaborate with team members to meet weekly enrollment goals.

The Skills, Experience & Education You Bring

• ​High school diploma or equivalent

• 3–5 years of healthcare credentialing and payer enrollment experience; IPA, physician group, or Revenue Cycle experience preferred.

• Excellent computer skills, including Microsoft Office (Word, Outlook, Excel, PowerPoint).

• Ability to use independent judgment and initiative within established policies and procedures.

• Strong relationship‑building skills across all levels of staff, management, and external payer contacts.

• Excellent written and verbal communication skills.

• Exceptional organizational skills and the ability to manage multiple projects concurrently.

• Ability to obtain,synthesize, andanalyzedataand recommend solutions.

• Ability to draft presentations, handouts, and communications.

• Demonstrates a learning and growth mindset; proactive and solution‑oriented.