Payer Enrollment Specialist

1 day ago

Norwood, Massachusetts, United States Pyramid Consulting, Inc Full time
Payer Enrollment Specialist Job Description

We are seeking a highly skilled Payer Enrollment Specialist to join our team at Pyramid Consulting, Inc. This is a contract opportunity with long-term potential and is located in Norwood, OH.

Job Summary:

The Payer Enrollment Specialist will be responsible for completing and reviewing provider applications with accuracy and thoroughness. This includes contacting providers for application information, contacting government agencies and managed care companies to obtain status and resolve discrepancies related to provider applications, and following up with physicians and assisting with completing applications.

Key Responsibilities:

  • Complete and review provider applications with accuracy and thoroughness.
  • Contact providers for application information, when necessary.
  • Contact government agencies and managed care companies to obtain status and resolve discrepancies related to provider applications.
  • Follow up with physicians and assist with completing applications.
  • Ensure timely submissions of all re-appointments and re-credentials, verifies all licenses are current, and maintains internal files, including copies of current credentials.
  • Follow up and communicate regularly with TCHMA Administration, Billing Dept. and Office Managers.
  • Maintain accuracy of and update CAQH database.
  • All other duties as assigned.

Requirements and Technology Experience:

  • Skills- CAQH, Cactus/Symplr, credentialing.
  • Must have 5+ years of experience in Physician/Advanced Practice Payer enrollment, in a hospital setting. Not with an insurance company.
  • Strong CAQH knowledge.
  • Strong Excel experience.
  • Cactus/Symplr experience.
  • Must have worked previously in a hospital system. Will not accept any Nursing, allied or agency credentialing specialist experience.
  • Preferred: Cactus/Symplr, CAQH experience.
  • 3-5 years' experience in credentialing.
  • Excellent computer skills, to include word processing, spreadsheet and database management.
  • Ability to work under pressure and adaptable to change.
  • Attention to detail and accuracy are essential.
  • High School Diploma or equivalent.

About Our Client:

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions.

Equal Employment Opportunity:

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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