Payor Enrollment Specialist

Job Description

A Payor Enrollment Specialist is responsible for provider enrollment intoFederal, State, and commercial health plans. The enrollment process begins with gathering provider data needed for enrollment and completion of provider applications. A Payer Enrollment Specialist also advises the provider’s office concerning best practices and procedures pertaining to enrollment. Regular correspondence and follow-up with provider’s office and health plans is essential until provider is fully enrolled.

SHIFT AND SCHEDULE

Full Time

Monday-Friday

8:00 a.m. - 5:00 p.m. 

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.• Ability to interact positively in a team environment, demonstrating superior teamwork skills.• Ability to manage assigned projects individually, without supervision and make independent decisions.• Superior attention to detail and organization skills• Excellent time management skills, resource organization and priority establishment skills, and ability to multi-task in a fast-paced environment.• Ability to effectively interface and communicate, both written and verbal, with all levels inside and outside the company.• Any other assigned responsibilities as requested by Supervisor, not specifically noted above.

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.

PHYSICAL REQUIREMENTSTo perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:· 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.