Payor Enrollment Specialist

At Aylo Health, we work together to enrich the health and well-being of every life we touch. Our mission is to make quality healthcare simple and convenient. Because healthy people can do amazing things!

We offer a work environment that values the creation of lifelong relationships, while also providing opportunities for growth and career development. We strive to care for each other with the same passion with which we care for our patients. Aylo Health offers competitive pay to team members who provide high-quality care, while delivering an exceptional patient experience.

Position Summary

The Payor Enrollment Specialist is responsible for coordinating and managing the enrollment, revalidation, maintenance, and termination of providers and facilities with commercial and government payors. This position ensures providers are enrolled accurately and in a timely to support uninterrupted reimbursement and compliance with regulatory and contractual requirements.

The specialist works closely with providers, practice operations, credentialing staff, payors, and revenue cycle teams to monitor enrollment status, resolve issues, and maintain accurate provider data across all systems.

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Key Responsibilities

Payor Enrollment Management

· Prepare, complete, and submit provider and facility enrollment applications to commercial, Medicare, Medicaid, and managed care payors.

· Manage new enrollments, revalidations, group affiliations, roster additions, demographic updates, and terminations.

· Monitor application status and proactively follow up with payors to ensure timely processing.

· Research and resolve enrollment delays, denials, and participation issues.

· Maintain detailed documentation of all enrollment activities and communications.

Provider and Facility Data Maintenance

· Ensure provider demographic information remains accurate across enrollment platforms and internal databases.

· Submit updates related to provider locations, tax IDs, NPIs, licensure, ownership changes, and other required information.

· Maintain provider records in credentialing and enrollment management systems.

· Perform regular audits to verify data integrity and compliance.

Collaboration and Communication

· Serve as a liaison between providers, practice leadership, credentialing teams, revenue cycle departments, and payors.

· Provide timely updates regarding enrollment status and expected effective participation dates.

· Assist with resolving network participation and reimbursement-related enrollment concerns.

· Respond to provider and stakeholder inquiries regarding enrollment requirements and processes.

Compliance and Quality Assurance

· Ensure enrollment activities comply with federal, state, accreditation, and payor requirements.

· Maintain knowledge of Medicare, Medicaid, and commercial payor enrollment guidelines.

· Support internal and external audits related to provider enrollment documentation.

· Adhere to organizational policies, procedures, and confidentiality requirements.

Reporting and Performance Monitoring

· Track enrollment metrics and maintain enrollment status reports.

· Identify enrollment trends, bottlenecks, and opportunities for process improvement.

· Assist leadership with reporting related to provider onboarding and enrollment performance.

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Required Qualifications

Education

· High School Diploma or GED required.

· Associate's or bachelor’s degree in healthcare administration, Business Administration, or related field preferred.

Experience

· Minimum 2 years of experience in provider enrollment, credentialing, revenue cycle, or healthcare administration.

· Experience working with commercial, Medicare, and Medicaid payor enrollment processes.

· Experience using credentialing and enrollment software platforms preferred.

Knowledge, Skills, and Abilities

· Knowledge of provider enrollment and credentialing principles and practices.

· Familiarity with Medicare PECOS, NPPES, CAQH ProView, and state Medicaid enrollment systems.

· Strong understanding of healthcare reimbursement and payor requirements.

· Excellent organizational and time management skills.

· Strong attention to detail and accuracy.

· Effective written and verbal communication skills.

· Ability to manage multiple priorities and deadlines in a fast-paced environment.

· Proficiency with Microsoft Office Suite, including Excel, Word, Outlook, and Teams.

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Preferred Qualifications

· Certified Provider Credentialing Specialist (CPCS) designation or willingness to obtain certification.

· Experience in a multi-specialty physician group, hospital system, or managed services organization.

· Knowledge of provider onboarding and credentialing workflows.

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Physical Requirements

· Prolonged periods of sitting and computer use.

· Ability to communicate effectively via phone, video conference, and email.

· Occasional lifting of up to 15 pounds.

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Success Metrics

· Timely submission of enrollment applications.

· Reduction in enrollment processing delays.

· Accuracy of provider data and enrollment records.

· Successful completion of revalidations and demographic updates.

· Provider onboarding completed within established organizational timelines.

· Maintenance of compliance with regulatory and payor requirements.

Equal Employment Opportunity Statement: The organization is committed to providing equal employment opportunities to all employees and applicants and prohibits discrimination and harassment of any type

Aylo Health is an Equal Opportunity Employer