Payer Relations Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the complete provider enrollment process, which encompasses initial enrollment, recredentialing, revalidation, and preparation for payer contracting.

• Act as a subject matter expert for clients regarding enrollment prerequisites, billing procedures, payer configurations, best practices, and compliance regulations.

• Prepare, finalize, and submit enrollment applications for individual providers and healthcare facilities across both commercial and government payers, including Medicare, Medicaid, and private insurance companies.

• Keep provider records accurate and up-to-date, including CAQH profiles, NPI registration, state license verifications, payer portal records, and other essential documentation.

• Monitor enrollment progress, renewal deadlines, expirations, recredentialing, and revalidation requirements; proactively follow up with payers to ensure timely processing and approvals.

• Engage directly with clients, providers, payers, and internal teams to collect necessary documentation, address enrollment-related challenges, and escalate issues as appropriate.

• Update, audit, and sustain provider participation status and demographic information within internal systems and credentialing databases.

• Ensure that payer setup and billing configurations align with contractual and regulatory standards; provide guidance to clients on billing structures and enrollment consequences.

• Remain informed about changes in payer requirements, healthcare regulations, and credentialing standards; utilize this knowledge to inform client recommendations and internal processes.

• Compile and present regular status updates, dashboards, and reports to clients and internal leadership.

• Lead or assist in enrollment audits and support the implementation of corrective action plans as necessary.

⛳️ Requirements

• Associate or Bachelor’s degree in healthcare administration, business, or a related field is preferred.

• A minimum of 3 years of experience in provider enrollment, payer enrollment, billing, credentialing, or a client-facing role within healthcare services.

• Proficient in Microsoft Office Suite and credentialing/enrollment systems or payer portals, such as CAQH, PECOS, Availity, and similar tools.

• Familiarity with commercial and government insurance payers, including understanding Medicare and Medicaid enrollment requirements.

• Strong attention to detail with the capability to maintain precise provider data, documentation, and enrollment records.

• Excellent written and verbal communication skills, along with strong organization, follow-up, problem-solving abilities, and customer service skills.

• Ability to juggle multiple priorities, meet deadlines, and work independently in a remote setting.

🏝️ Benefits

• Flexible remote work arrangement.

• Supportive environment fostering professionalism and teamwork.

• Opportunity to collaborate with highly qualified subject matter experts and operations executives.