Payor Enrollment Specialist

Overview

The Payor Enrollment Specialist plays a key role in managing provider Payor specific enrollment, Medicaid and Medicare revalidation processes, supporting onboarding workflows with MCOs and maintaining accurate spreadsheets including member and Provide rosters.  This position requires strong administrative skills, great organization skills and the ability to manage multiple deadlines simultaneously. The position will work closely with Credentialing Manager to managed care enrollment process for all providers.

Responsibilities

• Complete and submit new credentialing and re-credentialing applications, revalidations for Medicaid and Medicare.
• Follow up with insurance companies regarding credentialing status, missing documentation, approvals, and effective dates.
• Help identify and resolve credentialing or payer enrollment issues that may delay billing or payment.
• Maintain provider database in CAQH/AVAILITY and PAYERS
• Coordinate with internal teams and insurance representatives to resolve credentialing issues.
• Run monthly EPS (Excluded Providers list) for Staff and Referring Providers.
• Retrieve and request monthly member rosters and PCMH Provider rosters for reconciliation by the accounting department.
• Maintain accurate electronic records of provider credentials, licenses, insurance enrollments, and payer approvals
• Track responses and follows-up on items not received within established cycle periods. Initiates correspondence to providers, users, health plans and others as necessary to obtain requisite credentialing information
• Track expiration dates for provider licenses, credentials, CAQH profiles, and required documentation
• Organize and maintain digital copies of all provider licenses, certifications, and credentialing documents.
• Run monthly meetings with area Reps.
• Maintain spreadsheets by insurance; by providers with status updates and recertification dates.
• Maintain a high level of confidentiality with provider, client, and insurance information.
• Maintains monthly members rosters from MCOs and keeps accurate records of documents with expiration dates (license registration, board certifications, payors revalidation dates).

Qualifications

• High School Diploma or Equivalent required
• Basic Life Support/AED certification required.
• Strong oral, written and organizational skills required.
• Prior experience coordinating activities of a busy medical office or health care center, a plus.

Skills:

• Computer proficiency in all Microsoft Office Suite applications.
• Ability to deal effectively with a variety of people and work in a team environment.
• Excellent client /customer service orientation.