Payer Enrollment Specialist

About the Role

We are looking for a dedicated Payer Enrollment Specialist responsible for managing the enrollment and credentialing process of healthcare providers with multiple insurance payers, including commercial, Medicare, and Medicaid plans. This position plays a vital role in enabling providers to submit bills for services rendered and ensuring a smooth revenue cycle.

Key Responsibilities

• Prepare and submit applications for provider enrollment, re-enrollment, and re-credentialing across various payers including commercial insurance, Medicare, and Medicaid.
• Maintain thorough and up-to-date provider records such as licenses, certifications, and relevant credentialing documents, ensuring accuracy to avoid processing delays.
• Serve as the main liaison with payer contacts to monitor application progress, address inquiries, and resolve issues such as denials or requests for additional documentation promptly.
• Manage and update provider information in credentialing and billing platforms, including systems like CAQH and PECOS, ensuring data accuracy.
• Keep abreast of changes in payer enrollment rules and regulations to maintain compliance with state and federal standards.
• Collaborate closely with billing, coding, and provider relations departments to facilitate efficient onboarding and billing processes.

Qualifications & Experience

• Minimum of one year working experience in payer enrollment, credentialing, or medical billing within the US healthcare environment.
• Bachelor’s degree in healthcare administration or a related discipline is preferred.
• Proficient in the Microsoft Office Suite including Word and Excel.
• Experience with credentialing software or payer portals like CAQH and PECOS.

Key Skills

• Excellent attention to detail combined with strong organizational capabilities.
• Effective written and verbal communication skills.
• Ability to work independently, handle various deadlines, and solve problems efficiently.
• Good understanding of medical terminology and the US healthcare revenue cycle.