Payer Enrollments

Essential Responsibilities

• Coordinate with vendor to prepare, submit, and track provider enrollment, re-enrollment, and revalidation applications with commercial, Medicare, Medicaid, and other third-party payers.
• Monitor enrollment status and follow up with payers to ensure timely processing and approval.
• Maintain accurate provider demographic, licensure, credentialing, and enrollment data within internal systems.
• Cook up meetings with health plans and/or funders.
• Manage provider roster updates, contract participation changes, terminations, and practice location additions or closures.
• Research and resolve enrollment-related claim denials and reimbursement issues.
• Ensure compliance with payer requirements, regulatory standards, and organizational policies.
• Generate enrollment status reports and communicate progress to stakeholders.
• Serve as a subject matter expert regarding payer enrollment processes and requirements.
• Utilize credentialing and practice management software.
• Provide administrative support to the Credentialing Department as needed.
• Maintain confidentiality of sensitive provider and organizational information.

Qualifications & Skills

• Strong verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Able to manage multiple tasks and prioritize work effectively.
• Strong problem-solving and follow-up skills.
• Able to work independently and collaboratively in a fast-paced environment.
• Professional demeanor with strong customer service skills.
• Proficiency with Microsoft Office Suite, particularly Excel.
• Willingness to learn healthcare credentialing systems and payer portals.

Education & Experience

• High school diploma or equivalent; associate's or bachelor's degree preferred.
• 2+ years of healthcare payer enrollment, credentialing, revenue cycle, or related healthcare administration experience.
• Prior healthcare office, administrative, internship, or customer service experience required.
• Knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• Experience with credentialing, revenue cycle, or medical office operations.
• CPMSM, CPCS, CPES, or related industry certification is preferred but not required.

Work Environment

• This position operates in a professional office environment and routinely uses standard office equipment, including computers, phones, scanners, and copiers.
• While performing the duties of this position, employees are regularly required to sit, stand, walk, speak, hear, and use hands for computer and office work.
• Occasional lifting of office supplies up to 20 pounds may be required.

Schedule

• This is a full-time, in-office position.
• Standard hours are Monday through Friday based on organizational needs.