CVS Health
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose‑driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.
Position Summary The Payer Enrollment Lead Coordinator is responsible for ensuring the timely and accurate processing of payer enrollment applications, including initial submissions and revalidations for clinics and providers. This role supports compliance with Medicaid and Commercial programs by maintaining quality control over individual enrollment applications and resolving claims issues within the corporate billing system. The coordinator maintains credentialing and billing systems with updated provider information from Medicaid and Commercial payers, ensuring ongoing compliance through credentialing, re‑credentialing, and audit procedures. The coordinator proactively contacts providers upon receipt of revalidation notices to obtain necessary documentation and verify current information, while also managing escalations with field teams. The role identifies and analyzes trends or issues related to payer enrollment, communicates findings and potential impacts to management, and implements strategies to minimize denials and application deactivations—ultimately reducing key metrics such as DSO, cost to collect, aged claims, and bad debt.
What You Will Do
Submit, maintain, and monitor applications for initial enrollment and revalidation with government Medicaid payers and commercial payers for clinics and providers to ensure active participation.
Assist in developing and improving payer workflow while ensuring compliance with the company’s regulatory, safety, quality, and confidentiality protocols and standards.
Ensure the timely and accurate submission of group and provider enrollment applications for Medicaid and commercial programs, supporting compliance and operational efficiency across payer relations.
Follow up on status and elevate as needed to overcome barriers and proactively address and resolve requests and issues.
Minimize the deactivation of government program applications by adhering to established quality control procedures. Serve as a key point of contact for escalated claim issues received from internal departments, coordinating with payers to identify and implement solutions. Communicate resolutions and relevant updates to appropriate internal stakeholders to ensure alignment and continuity.
Maintain accurate and up‑to‑date credentialing and billing systems by updating provider information upon inquiry or receipt from payers. Develop and maintain state‑specific summaries, policies, procedures, and training modules to support operational consistency. Conduct research to identify potential issues, formulate solutions, and ensure timely resolution. Communicate updates and relevant information to field teams as needed to ensure alignment and awareness.
Conduct research and analysis of trends related to claims, providers, and clinics to identify opportunities for process improvements and system efficiencies. Maintain a weekly issue log documenting all provider‑payer issues by state. Collaborate with senior and centralized provider managers to ensure accurate provider enrollment across locations, reporting discrepancies and recommending corrective actions. Review claims for trends, errors, enrollment status, insurance package accuracy, and non‑billable services to support resolution and operational integrity.
Required Qualifications
2+ years of general work experience.
2+ years of experience using Excel.
2+ years of experience using Outlook in a professional setting.
This is a hybrid position with a set schedule that requires regular in‑office attendance.
Preferred Qualifications
Medicare/Medicaid experience on the provider side.
Adept at problem solving and decision‑making skills.
Ability to work independently.
Willingness to learn.
Education High School Diploma or GED
Anticipated Weekly Hours 40
Time Type Full time
Pay Range $18.50 – $38.82 (base hourly rate or base annual full‑time salary). The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short‑term incentive program in addition to the base pay range listed above.
Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional, and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues, including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 10/24/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
Position Summary The Payer Enrollment Lead Coordinator is responsible for ensuring the timely and accurate processing of payer enrollment applications, including initial submissions and revalidations for clinics and providers. This role supports compliance with Medicaid and Commercial programs by maintaining quality control over individual enrollment applications and resolving claims issues within the corporate billing system. The coordinator maintains credentialing and billing systems with updated provider information from Medicaid and Commercial payers, ensuring ongoing compliance through credentialing, re‑credentialing, and audit procedures. The coordinator proactively contacts providers upon receipt of revalidation notices to obtain necessary documentation and verify current information, while also managing escalations with field teams. The role identifies and analyzes trends or issues related to payer enrollment, communicates findings and potential impacts to management, and implements strategies to minimize denials and application deactivations—ultimately reducing key metrics such as DSO, cost to collect, aged claims, and bad debt.
What You Will Do
Submit, maintain, and monitor applications for initial enrollment and revalidation with government Medicaid payers and commercial payers for clinics and providers to ensure active participation.
Assist in developing and improving payer workflow while ensuring compliance with the company’s regulatory, safety, quality, and confidentiality protocols and standards.
Ensure the timely and accurate submission of group and provider enrollment applications for Medicaid and commercial programs, supporting compliance and operational efficiency across payer relations.
Follow up on status and elevate as needed to overcome barriers and proactively address and resolve requests and issues.
Minimize the deactivation of government program applications by adhering to established quality control procedures. Serve as a key point of contact for escalated claim issues received from internal departments, coordinating with payers to identify and implement solutions. Communicate resolutions and relevant updates to appropriate internal stakeholders to ensure alignment and continuity.
Maintain accurate and up‑to‑date credentialing and billing systems by updating provider information upon inquiry or receipt from payers. Develop and maintain state‑specific summaries, policies, procedures, and training modules to support operational consistency. Conduct research to identify potential issues, formulate solutions, and ensure timely resolution. Communicate updates and relevant information to field teams as needed to ensure alignment and awareness.
Conduct research and analysis of trends related to claims, providers, and clinics to identify opportunities for process improvements and system efficiencies. Maintain a weekly issue log documenting all provider‑payer issues by state. Collaborate with senior and centralized provider managers to ensure accurate provider enrollment across locations, reporting discrepancies and recommending corrective actions. Review claims for trends, errors, enrollment status, insurance package accuracy, and non‑billable services to support resolution and operational integrity.
Required Qualifications
2+ years of general work experience.
2+ years of experience using Excel.
2+ years of experience using Outlook in a professional setting.
This is a hybrid position with a set schedule that requires regular in‑office attendance.
Preferred Qualifications
Medicare/Medicaid experience on the provider side.
Adept at problem solving and decision‑making skills.
Ability to work independently.
Willingness to learn.
Education High School Diploma or GED
Anticipated Weekly Hours 40
Time Type Full time
Pay Range $18.50 – $38.82 (base hourly rate or base annual full‑time salary). The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short‑term incentive program in addition to the base pay range listed above.
Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional, and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues, including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 10/24/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr