Address
Form of work
SalaryGENERAL SUMMARY OF DUTIES: The Payer Enrollment Specialist will be responsible for evaluating, analyzing, and coordinating all aspects of the Payer Enrollment process for practitioners to enable timely onboarding of healthcare providers.
RESPONSIBILITIES:
Duties may include but are not limited to:
Duties may include but are not limited to:
- Initiates and supports Payer Enrollment process by requesting, receiving, validating and submitting Payer Enrollment applications for new providers and provider changes
- Completes payer revalidations for providers and entities on payer-specific cadence
- Maintains and manages payer portal access for providers and entities
- Provides updates to payers on provider and entity records related to banking information, EFT, correspondence address, ownership, etc.
- Responsible for accurate data entry to ensure data integrity
- Maintains accurate records in Payer Enrollment software and on shared drive
- Collaborate with Revenue Cycle department on claim denials, rejections or inquires due to enrollment
- Communicates with payer representative to address payer concerns
- Responds to all practitioner, health plan and internal inquiries in a timely manner
- Collaborates with participating clients, department manager and /or external agencies to facilitate and ensure smooth hand-off during the Payer Enrollment process
- Uses critical thinking skills to conduct follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the Payer Enrollment process
REQUIRED EDUCATION, SKILLS & EXPERIENCE:
Bachelor’s degree in business, healthcare or related filed and 3-5 years of progressive experience in Payer Enrollment strongly preferred. 10+ years of credentialing/enrollment and/or revenue cycle management experience may be substituted in place of a degree.
Working knowledge of credentialing and enrollment software preferred, ideally Verity Credential Stream. Knowledgeable in all aspects of Payer Enrollment, including knowledge of regulatory & compliance standards, as well as commercial and government insurance enrollment. Must be proficient in Microsoft Office suite. Strong communication skills from team level to peer level to C-suite level required.
PHYSICAL/MENTAL/ENVIRONMENTAL DEMANDS
Requires sitting and standing associated with a normal office environment. Travel (local and nationwide) as business needs dictate.
