Payer Enrollment Specialist
2 weeks ago
Join DCH Health System as a key member of our revenue cycle management team and take on the challenge of optimizing our payer enrollment processes. As a Payer Enrollment Specialist, you will be responsible for ensuring accurate and timely enrollment with various payers, maintaining compliance, and collaborating with internal teams to enhance financial performance.
Key Responsibilities:- Facilitate the enrollment and credentialing process with various payers, including government programs and private insurers.
- Maintain up-to-date knowledge of payer regulations, guidelines, and requirements to ensure compliance.
- Collaborate with internal stakeholders, including billing and coding teams, to resolve payer-related issues and streamline processes.
- Perform thorough verification and validation of provider information to prevent enrollment delays and billing errors.
- Stay informed about changes in healthcare policies, reimbursement rates, and coding standards that may impact payer enrollment.
- Develop and maintain strong relationships with payer representatives to expedite and troubleshoot enrollment processes.
- Generate reports and analyze data related to payer enrollment, providing insights to improve efficiency and revenue outcomes.
- Participate in training sessions and workshops to enhance knowledge and skills related to payer enrollment and healthcare regulations.
- Associate's degree in healthcare administration, business, or a related field required OR High School diploma or GED with 3+ years' experience in hospital and physician enrollment.
- Bachelor's degree in healthcare administration, business, or a related field preferred.
- Prior experience in healthcare payer enrollment, credentialing, billing or related roles.
- Strong understanding of healthcare regulations, payer policies, and reimbursement processes.
- Excellent organizational and communication skills, with attention to detail.
- Proficiency in using relevant software and databases for enrollment and data analysis.
- Ability to work independently and collaboratively in a dynamic healthcare environment.
- Coordinate and lead others.
- Deal with external customers/vendors.
- Provide business appropriate letters, memos, and emails.
- Public speaking.
- Work well within a group or team.
- Freedom of decision making without supervision.
- Understanding impact of decisions on the Health System.
- Fast-paced and under time pressure.
- The Americans with Disabilities Act (ADA) requires the job description to document physical factors, including ability, activities, and requirements.
- Ability: Gross Body Equilibrium and Coordination.
- Activities: Talking, hearing, walking, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls.
- Requirements: Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
- Deductive reasoning, fluency of ideas, problem sensitivity, oral comprehension, oral expression, written expression, speed of closure.
- Achieve goals set forth in job, ability to adapt to surroundings and continuous change, attention to detail, initiative, independence, stress tolerance, leadership, integrity and cooperation.
- Ability to build relationships, create a support structure for those in the Health System, provide recognition to those achieving the accolades, and satisfy work task independently.
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