Job Description

The Payer Enrollment Specialist role is responsible for remotely obtaining and maintaining payer participation with government and commercial health plans and assisting in enrollment issues as they relate to payer enrollment and claims payment. The Payer Enrollment Specialist will work closely with HR, the clinicians, Clinic Directors and staff to collect all items needed to obtain and maintain all payer participation.


Essential Functions:

  • Manage the completion, submission and re-credentialing of provider enrollment applications
  • Track current status of applications, follow up as necessary and document activity in an accurate and timely manner
  • Prepare the CAQH for newly affiliated and existing providers to include re-attestation 
  • Research and resolve provider related enrollment issues and coordinate with team members of various departments when applicable
  • Maintains confidentiality of provider information
  • Maintain the physician’s files for revalidation of Medicare via PECOS
  • Maintain and update provider files and rosters including but not limited to internal provider and/or location data, individual CAQH profiles, payer databases, NPI database and Medicare database, and any other as needed
  • Assist providers with completion of applications and credentialing paperwork
  • Advises management team of any potential delays in a providers’ credentialing and works with billing operations staff in resolving billing issues related to payer credentialing issues
  • Review provider credentialing files and work with providers to obtain the necessary missing, incomplete and expiring items
  • Proficient in Microsoft Excel 
  • Stays abreast of current health plan and agency requirements for credentialing providers
  • Communicates appropriately with Physician’s regarding credentialing and insurance enrollment for new providers and new practices with government and commercial insurance payers

    • Required Skills & Abilities:

  • Ability to type 60 words per minute preferred.

  • Ability to work remotely in a structured, set-hours environment

  • Proven ability to handle high volume with accuracy and urgency.
  • Physician and Payer Credentialing Experience. 
  • Great customer service skills. 
  • Strong interpersonal, oral (includes telephone skills) and written communication skills.
  • Ability to manage multiple streams of work simultaneously using good planning, organization, multi-tasking, and prioritization in order to meet deadlines
  • Complete understanding of medical reimbursement and terminology.
  • Ability to work with disabled individuals. 

    • Required Credentials:

  • High School Diploma.
  • PECOS expierence required.
  • Payer Enrollment Expierence required.
  • Working knowledge of CAQH Proview required.
  • Minimum 3 years of experience credentialing for Managed Care Insurance Enrollment, Medicare (PECOS) and Medicaid.
  • Knowledge of payer credentialing process, ability to organize and prioritize work and manage multiple priorities, excellent verbal and written communication skills, ability to research and analyze data, work independently, and establish and maintain effective working relationships essential.
  • Advanced skills with Microsoft applications which may include Echo/One App, Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases. 

    • Compensation:

  • $20 - $24 hourly. (Any posted pay range considers a wide range of compensation factors, including candidate background, experience, and work location, while also allowing for salary growth within the Up to $300 monthly bonus based on performance and exceeding mandatory KPIs

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