Provider Enrollment Specialist
About the job
- An associate's degree is required; a bachelor's degree in any related field is preferred.
- Working knowledge of application requirements for Centers for Medicare & Medicaid Services, State Medicaid, and third-party payers, including prerequisites, required forms and completion requirements, supporting documentation such as Drug Enforcement Agency numbers and curricula vitae, and applicable regulations.
- Working knowledge of physician Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security policies and procedures.
- Strong oral, written, and interpersonal communication skills.
- Strong word processing, spreadsheet, database, and presentation software skills.
- Strong attention to detail, analytical, decision-making, problem-solving, organizational, and time-management skills.
- Ability to ensure complex enrollment packages are complete and correct.
- Ability to work independently with little supervision and accomplish tasks.
- Ability to maintain strict confidentiality regarding protected provider and health information.
- Ability to take initiative and troubleshoot effectively while focusing on innovative solutions.
- Ability to exercise sound judgment and appropriately handle highly sensitive and confidential information.
- Ability to remain flexible in a collaborative, fast-paced environment.
- Ability to communicate tactfully, maturely, and professionally with diverse personalities.
- Follow up with market locations to research and resolve payer enrollment issues.
- Follow up with Centers for Medicare & Medicaid Services and other payers by phone, email, or website to resolve payer enrollment issues.
- Manage completion and submission of Centers for Medicare & Medicaid Services Medicare, State Medicaid, and other third-party payer applications.
- Track and follow up to ensure provider numbers are established and linked to the appropriate client group entity and software systems.
- Maintain documentation and reporting regarding payer enrollments in process.
- Retain records related to completed Centers for Medicare & Medicaid Services applications.
- Establish close working relationships with clients, operations personnel, and the Revenue Cycle Management team.
- Obtain, track, and manage payer revalidation dates for assigned groups and providers; complete, submit, and track required applications to maintain active enrollment and prevent deactivation.
- Maintain provider demographics in applicable enrollment systems.
- Add providers to applicable systems and maintain information to ensure claims are held or released based on enrollment status.
- Perform special projects and other assigned duties.
- At least one year of provider enrollment experience is preferred.
- Ability to work cohesively in a team-oriented environment.
- Ability to foster effective working relationships with people inside and outside the organization.
About the company
Ventra Health provides business solutions for facility-based physicians in anesthesia, emergency medicine, hospital medicine, and radiology. Its offerings help physicians manage clinical and administrative operations, including revenue cycle management, scheduling, coding, documentation, and compliance so they can run their practices more efficiently. The product works by combining software tools with professional services tailored to the needs of these specialties, embedding workflows that streamline billing, patient throughput, and regulatory adherence. Ventra Health differentiates itself by focusing specifically on the unique needs of facility-based physicians and groups, offering integrated solutions designed for hospital-based practices rather than traditional solo clinics. The company’s goal is to improve financial performance, operational efficiency, and care delivery for its physician customers.
Company Size
1,001-5,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Dallas, Texas
Founded
2021
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Simplify's Take
What believers are saying
- Ventra says vCision lifted first-pass payment rates 19% and cut denials 26%.
- The June 2026 Radix Health partnership expands Independent Dispute Resolution for out-of-network claims.
- Ventra added a Global Capability Center in 2026 to scale engineering and data delivery.
What critics are saying
- Ventra faces 24 BBB complaints in three years, including six closures since September 2025.
- CitiusTech and vCision invite rapid imitation from Waystar, R1 RCM, and Epic.
- If vCision misses savings targets, Ventra becomes a commodity RCM platform by 2027.
What makes Ventra Health unique
- Ventra Health combines RCM, physician advocacy, and payer strategy across anesthesia through radiology.
- David Sides joined May 11, 2026, bringing NextGen Healthcare and Teladoc execution.
- vCision, launched January 2026 with CitiusTech, embeds agentic AI inside workflows.
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Benefits
- Performance Bonus
- Employee Referral Bonus