Payer Enrollment Specialist
1 month ago
The successful candidate will be responsible for managing the enrollment of providers with payers ensuring timely and accurate submission of applications. This role is crucial for ensuring efficient billing processes and optimizing revenue flow.
What you will do:
- Prepare, submit, and monitor provider enrollment applications with various payers, including Medicaid, MCOs, and private insurance companies.
- Stay informed about changes in payer enrollment requirements and ensure compliance with all applicable standards.
- Liaise with healthcare providers and internal teams to gather necessary documentation and resolve issues related to provider enrollment.
- Manage the status of applications, follow up on pending items, and expedite processes where necessary.
- Maintain accurate and up-to-date records in the provider database and ensure all enrollment information is current.
- Support audits and participate in regulatory compliance reviews.
- Build and maintain effective relationships with payers to facilitate communication and swift resolution of issues.
- Provide regular reports to management on the status of enrollments and highlight potential concerns impacting billing and reimbursement.
Experience and Skills:
- Minimum of two years of experience in provider enrollment or credentialing, preferably in a healthcare setting.
- Comprehensive understanding of payer guidelines and the credentialing process.
- Excellent organizational skills and attention to detail.
- Strong communication and interpersonal skills, capable of effectively interacting at all levels of the organization.
- Proficient in MS Office and familiar with credentialing databases and software.
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