Payer Enrollment Specialist

2 weeks ago


Tuscaloosa, Alabama, United States DCH Health System Full time
Payer Enrollment Specialist

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.
Requirements:
  • 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.
Working Conditions:
  • 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.
Physical Factors:
  • 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.
Other Job Factors:
  • 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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