Provider Enrollment and Compliance Analyst

Job Summary

The Provider Enrollment and Compliance Analyst supports the Revenue Cycle by managing all facility – and hospital-focused enrollment activities with the Centers for Medicare and Medicaid Services (CMS), state Medicaid programs and other commercial payers. This role is accountable for initial enrollments, revalidations, changes, updates and terminations to ensure ongoing billing compliance and minimize enrollment-related revenue risk.

In addition to leading facility enrollment work, this position will also provide flexible support to professional provider enrollment activities and strategic system projects as business needs require. The role functions as a hybrid between an enrollment coordinator and analyst, requiring strong regulatory knowledge, attention to detail and the ability to apply CMS enrollment rules consistently across a large, integrated healthcare system.

Essential Functions

• Manage all CMS Medicare, Medicaid and Commercial enrollments for hospitals, facilities and organizational billing entities across the health system.
• Prepare, submit, and track CMS-855 applications, state Medicaid enrollment forms, commercial enrollment forms, revalidations and payer notifications.
• Maintain accurate enrollment records for facility and hospital NPIs, PTANs, taxonomies, ownership disclosures and practice locations
• Ensure timely filing of changes, updates, additions and terminations in accordance with CMS and state regulatory timelines.
• Serve as the subject matter expert for facility enrollment compliance, identifying risks associated with delayed or incomplete filings.
• Interpret and apply CMS and Medicaid enrollment regulations to support compliant billing and reduce audit exposure.
• Monitor enrollment status and proactively address pending, expiring, or at-risk enrollments.
• Partner with Revenue Integrity, Professional Billing, Compliance, New Programs & Integrations and Operational leaders to resolve enrollment-related impacts.
• Respond to payers, CMS, or Medicaid inquiries related to enrollment status or documentation, partnering with internal stakeholders as needed.
• Provide support across all provider enrollment work during high-volume periods and coverage gaps.
• Support standardization of facility enrollment workflows, documentation requirements, and internal guidance.

Qualifications

Required

• Bachelor's Degree or equivalent in business, Healthcare Administration, Health Information Management or a related field OR equivalent relevant experience.

• 2 years of relevant experience in experience in provider enrollment, facility enrollment, credentialing or revenue cycle operations.
• Working knowledge of CMS Medicare and Medicaid enrollment requirements, including CMS-855 forms and revalidation processes.
• Demonstrated ability to manage complex, detail-driven work with regulatory deadlines and compliance implications.
• Strong written and verbal communication skills.

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status