Payor Enrollment Specialist

Essential Functions/Performance Expectations

• Communicate and advise designated contact person of the paperwork necessary to begin the application process for new providers, including any necessary research to gather all details to appropriately enroll provider.
• Communicate and advise the provider or designated contact person of the sequential steps needed to begin the enrollment process through completion and set timeline expectations.
• Maintain contact with designated contact person to obtain application signatures and collect all required documents to include with the completed applications.
• Key all provider demographics & enrollment data into software system.
• Scan all related enrollment documents and applications into software system.
• Contact health plans to request provider enrollment application packages and/or required action for enrollment and continue follow-up with insurance plans by telephone or email until all provider numbers are issued.
• Prepare and distribute Payor Affiliation Reports and Status Notes to designated contact person(s) for each provider every 2-3 weeks in order to communicate the progress of approved provider numbers.
• Prepare and submit monthly invoices in accounting software showing new work and completed work.

Physical Requirements

• Stand, walk, sit, stoop, reach, lift, see, speak and hear.
• Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff.
• The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.

Education And Experience

• Experience in Payor/Provider Enrollment or Credentialing required.
• Minimum of 2 years of college experience or directly applicable experience in payor enrollment required.
• Experience with Microsoft Office Suite including Word, Excel and Teams.