Senior Payer Enrollment Specialist

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

📋 Description

• Oversee the initial and recredentialing enrollment of payers for groups, facilities, physicians, and APPs across various insurance plans.

• Facilitate the incorporation of new service locations and ensure accurate participation in payer contracts.

• Administer monthly submissions of the payer roster and uphold effective workflows, policies, and procedures for enrollment.

• Leverage payer portals, such as Availity, UHC, Kaiser, and LexisNexis, for managing enrollment and provider data.

• Ensure the accuracy of provider, practice, and group information across NPPES, CAQH, payer portals, and directories.

• Perform quarterly attestations of provider data and confirm the validity of demographic and participation details.

• Audit enrollment activities and documentation to ensure accuracy, compliance, and adherence to set processes.

• Investigate and resolve issues related to payer enrollment while ensuring that provider information aligns with payer and organizational standards.

• Manage malpractice insurance certificates and oversee the annual renewals of Certificates of Insurance.

• Provide support, training, and mentorship to the payer enrollment team and contribute to departmental initiatives and special projects.

• Identify and enact process improvements that boost enrollment efficiency, accuracy, and team performance.

⛳️ Requirements

• An associate degree along with three years of payer enrollment experience, or five years of experience in place of a degree.

• A bachelor's degree is preferred.

• Certifications such as CPCS, CPES, RHIA, or RHIT are preferred; CPCS certification is mandatory within two years if not already obtained.

• Familiarity with payer enrollment, provider participation, and relevant regulatory requirements.

• Proficient in Microsoft Office, CAQH ProView, NPPES, OIG, and payer portals.

• Exceptional attention to detail, organizational skills, and documentation abilities.

• Professional and effective communication with both internal and external stakeholders.

• Capability to maintain confidentiality while managing sensitive provider and organizational information.

• Ability to effectively research and resolve payer enrollment and provider data issues.

• Competence in managing multiple priorities and meeting deadlines in a fast-paced setting.

• Strong skills in customer service, problem-solving, teamwork, and adaptability.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) plan with company matching.

• Tuition assistance and support for professional development.

• Opportunities for performance-based bonuses.

• Generous paid time off, holidays, and parental leave.

• Life and disability insurance benefits.

• Fertility Discount Program.

• Employee wellness and recognition initiatives.