Payer Relations Specialist

About the role

The organization operates within the telehealth industry, focusing on providing medical services to individuals with intellectual and developmental disabilities (I/DD). It addresses the challenge of limited access to specialized healthcare for this population by employing board-certified clinicians trained specifically in I/DD care. Services are accessible 24/7 via telemedicine for urgent and non-urgent issues, including scheduled psychiatry visits, facilitating faster access to quality care and reducing unnecessary medical costs. The Payer Relations Specialist role supports the organization's healthcare provider network by managing the enrollment and credentialing processes with insurance companies. This position ensures that providers are accurately and timely credentialed and re-credentialed to participate in payer networks, directly impacting the organization’s ability to deliver services efficiently and maintain compliance with payer requirements.

Responsibilities

• Prepare and submit initial and renewal credentialing and enrollment applications for healthcare providers with commercial and government payers
• Track and follow up on application statuses to ensure timely processing and resolve delays
• Maintain accurate provider data within internal and external portals and databases
• Act as a liaison among providers, internal teams, and insurance companies regarding credentialing and enrollment
• Ensure compliance with payer policies and regulatory standards
• Troubleshoot and resolve contracting and enrollment issues through cross-functional collaboration
• Monitor provider licenses, certifications, and insurance expirations

Requirements

• Associate’s degree or equivalent experience in healthcare or business administration
• At least 4 years of experience in credentialing and payer enrollment
• Strong knowledge of health insurance payers and reimbursement processes
• Experience with credentialing or payer enrollment tracking software such as Medallion
• Excellent written and verbal communication skills
• Strong organizational skills and attention to detail
• Ability to analyze data and identify trends
• Commitment to improving access to quality healthcare for individuals with Intellectual and Developmental Disabilities