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SalaryAbout the Role:
The Payer Enrollment Specialist role is a vital position within our Credentialing and Contracting team, entrusted with overseeing all aspects of payer contracting lifecycle. Your deep passion for supporting the underserved trans community and eagerness to play a crucial role in broadening access to care are invaluable.
This role is a key part of our fee-for-service reimbursement strategy, offering a unique opportunity for motivated individuals to make an immediate and significant impact. As a Payer Enrollment Specialist, you'll be at the forefront of developing and executing our payer contract management initiatives, playing an integral role in fostering strong payer relationships and managing contracts efficiently, contributing significantly to the operational success of our organization. If this sounds like the right challenge for you, we encourage you to apply and join us in making a difference.
Responsibilities:
Payer Relationship Management:
- Build and maintain strong relationships with payer partners.
- Advocate for organizational interests and collaborate for mutual success.
- Drive performance improvement initiatives with internal teams and payer partners.
Contract and Rate Management:
- Maintain and update contract rates, including yearly governmental changes.
- Identify payment discrepancies and market trends to optimize collections.
Contract Review and Coordination:
- Assess initial contract terms for Operations and Finance.
- Review and summarize contract amendments.
- Coordinate document submission for new payer contracts.
Communication and Data Management:
- Communicate new payer developments to relevant departments.
- Manage payer dashboard access for new hires and terminated employees.
Interdepartmental Collaboration:
- Work across departments to solve contract/credentialing issues.
Additional Responsibilities:
- Undertake other duties as required for organizational support.
Must-Haves:
- A passion for and affinity with the mission of Plume, to transform healthcare for every trans life
Relevant Experience and Skills:
- Proven track record in payer contracting and provider credentialing, with at least two years of experience.
- Manage the research, preparation, and submission of contract applications, including credentialing and enrollment forms as required by plans. Diligently track and report on the progress of each submission.
- Familiarity with various insurance plans and healthcare payment systems.
- Proficiency in managing relationships with insurance payers.
Knowledge of Healthcare Regulations:
- Understanding of healthcare regulations, including HIPAA, and federal and state laws.
- Familiarity with the specifics of credentialing standards and processes.
- NCQA knowledge is a plus.
Strong Communication Skills:
- Ability to effectively communicate with various stakeholders, including insurance representatives, healthcare providers, and team members.
- Skilled in both written and verbal communication.
Analytical and Problem-Solving Abilities:
- Ability to identify and resolve discrepancies and issues in payer contracts.
Organizational Skills:
- Strong organizational and time-management skills, with an ability to prioritize tasks effectively.
Cultural Competency and Sensitivity:
- Demonstrated understanding and empathy towards the trans experience.
- Commitment to inclusivity and respectful communication.
Educational Background:
- A degree in healthcare administration, business, or a related field.
- Certifications related to healthcare contracting or credentialing can be a plus.
Technology Proficiency:
- Familiarity with healthcare IT systems, credentialing databases (Salesforce), and GSuite.
Adaptability and Continuous Learning:
- Ability to adapt to a changing healthcare landscape.
- Commitment to staying updated on industry trends and best practices.
Team Collaboration:
- Ability to work collaboratively within a team, contributing positively to team dynamics.
Compensation and Benefits:
- $60k - $70k DOE
- Ground-Floor Equity
- Competitive Benefits & Perks
- Free Plume Membership
