ABOUT US
Circle Medical is a venture-backed Y-Combinator healthcare startup on a mission to make high quality healthcare accessible through technology that empowers providers and elevates the patient experience. Built by top-tier physicians, engineers, and designers, our medical practice and underlying technology have pioneered how people find and receive care. More about us can be found on our website.
DESCRIPTION
The Medicare Enrollment Specialist is responsible for managing the full cycle of Medicare enrollment for both individuals and group entities. This role ensures timely and accurate submission of enrollments though PECOS, manages surrogacy access requests, updates provider data in NPPES, and communicates enrollment statuses to internal stakeholders. The ideal candidate will bring strong attention to detail, organizational skills, and a deep understanding of Medicare enrollment processes and compliance requirements.
KEY RESPONSIBILITIES
• End-to-End Enrollment Management: Prepare and submit complex initial, reassignment, and change of information enrollments in the PECOS system for both individuals and the organization, including sensitive ownership changes and new location additions, ensuring 100% data accuracy.
• Provider Engagement & Support: Act as a trusted point of contact for providers, assisting with pending surrogacy requests, signing pending enrollments, I&A system login issues, and providing expert-level support via phone, email, or online platforms.
• Regulatory Compliance & Auditing: Proactively ensure all enrollment activities strictly adhere to federal regulations, including CMS and HIPAA requirements. Participate in internal audits to maintain a high standard of compliance.
• Inquiry & Escalation Resolution: Respond promptly and professionally to internal and external inquiries related to enrollment, eligibility, application status, or complex payer issues, serving as the subject matter expert.
• Data Integrity & Maintenance: Maintain impeccably accurate and up-to-date provider enrollment data across NPPES and internal credentialing softwares, identifying and correcting discrepancies immediately.
• Status Tracking & Communication: Meticulously record and track all enrollment approvals, denials, reconsiderations, and appeals within Credentialing systems, providing clear, timely, and actionable updates to Revenue Cycle, Credentialing, and Operations teams.
• Process Improvement & Documentation: Maintain and proactively update Standard Operating Procedures (SOPs) to reflect current processes, regulatory changes, and updated CMS guidance, contributing to team efficiency and knowledge sharing.
Soft Skills & Core Competencies
• Exceptional Attention to Detail & Accuracy: Possesses a meticulous, error-averse work ethic with an unwavering focus on data accuracy and completeness across all systems (PECOS, NPPES, internal software).
• Consultative Communication: Demonstrates clear, professional, and empathetic verbal and written communication, capable of translating complex regulatory requirements into understandable guidance for providers and internal teams.
• Analytical Problem-Solving: Ability to analyze, troubleshoot, and resolve complex enrollment discrepancies, denials, or system issues with minimal supervision, exercising sound judgment in decision-making.
• Organizational Mastery & Time Management: Proven ability to prioritize and manage a high-volume pipeline of enrollment cases simultaneously, effectively meeting strict regulatory and internal deadlines in a remote environment.
• Accountability & Adaptability: Exhibits a high degree of self-motivation, ownership, and accountability for enrollment outcomes, and demonstrates flexibility to adapt to frequent and critical regulatory changes from CMS.
• Confidentiality & Discretion: Handles all provider data and Protected Health Information (PHI) with the utmost confidentiality in strict adherence to HIPAA guidelines.
Education & Experience
Required Education:
• High School Diploma or GED
Required Experience:
• Minimum of 5 years of dedicated experience in payer enrollment and/or credentialing or equivalent demonstrated competency.
• Minimum of 3 years of hands-on, expert experience using the PECOS system with a strong, current knowledge of CMS enrollment requirements and processes.
Preferred Qualifications:
• Associate’s or Bachelor’s degree in Healthcare Administration, Business, or a related field.
• Experience with a major credentialing software (e.g., Modio, Cactus, Symplr, MedTrainer).
• Experience supporting enrollment for a multi-state organization.
COMPENSATION
In alignment with our values, Circle Medical has transparent salaries based on output levels, and options to trade cash for stock.
This is a full-time, non-exempt position with an hourly range of $22 to $27 plus, generous benefits.
Benefits
• Flexible vacation & sick leave (eligibility after 90-days)
• 10 paid holidays
• $500 annual education and development reimbursement
• Medical, Dental, Vision benefits, Life & additional supplemental coverage options
• 401K + Company Matching Program per eligibility