Payer Enrollment Specialist - FT - Day Shift

Job Summary

Responsible for day-to-day payer enrollment and credentialing services tasks to include payer enrollment, revalidations, and other miscellaneous tasks as required by payers; serves as initial point of contact for contracted providers, insurances and other related entities. Assist with policy and procedure interpretation.

Duties and Responsibilities

• Work with contracted providers to meet all their credentialing service expectations outlined in the contracts between MMH and its payers.
• Work closely with the Medical Staff Coordinator to ensure consistency between enrollment information and credentialing information to make the onboarding process as smooth as possible.
• Communicate proactively with leadership, managers, the Medical Staff Coordinator and others as necessary to ensure that providers do not start working unless they are successfully enrolled, and we will be paid for their work.
• Complete the processes to enroll and credential providers (e.g. physicians, facilities, physician assistants, nurse practitioners, etc.) with insurances while meeting payer criteria.
• Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.
• Complete the processes to re-credential existing providers.
• Gather and maintain current data and documents for all providers in an organized and complete way.
• Monitor and track payer enrollment timelines, deadlines, and ensure compliance with submission requirements. Follow up with clients and insurances during the credentialing process as needed.
• Investigate and resolve enrollment delays, rejections, or discrepancies by communicating with providers and payers.
• Review remittances, EOBs and payment information from payers as requested.
• Assist with payer audits, questions and reviews.
• Clearly and effectively communicate with providers, managers and insurance companies handling basic questions dealing with the day-to-day operation of enrollments.
• Review, and update, if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information.
• Assist with revalidation processes to ensure provider participation in health plans remains active.
• Maintain a knowledge of provider credentialing/accreditation/insurance regulations on a state and federal level, policies, guidelines, and industry best practices for enrollment processes.
• Other duties as assigned.

Minimum Requirements

• High school degree or equivalent
• 2 years of experience in provider enrollment, credentialing, or a healthcare administrative role

Preferred Requirements

• Associate’s degree in a business or healthcare related field or equivalent experience.

Skills/Competencies

• Strong organizational and time-management skills with the ability to handle multiple priorities.
• Detail-oriented and able to ensure the complex enrollment packages are complete and correct.
• Able to communicate well with a wide variety of internal and external contacts at all levels of the organization.
• Must be able to work cohesively in a team-oriented environment and be able to foster good working relationships with others, both within and outside the organization.
• Strong analytic and problem-solving capabilities coupled with the ability to work under pressure of strict deadlines.
• Able to maintain confidentiality and work independently.
• Excellent computer literacy and skills with the ability to use PC software (Microsoft Office-Excel, Word, PowerPoint) with the ability to master programs and processes necessary for the position.

Physical Requirements

Perceive the nature of sounds by the ear, express or exchange ideas by means of spoken word, perceive characteristics of objects through the eyes, extend arms and hands in any direction, seize, hold, grasp, turn, or otherwise work with hands, pick, pinch, or otherwise work with fingers, perceive such attributes of objects or materials as size, shape, temperature, or texture; and stoop, kneel crouch, and crawl. Must be able to lift 25 pounds maximum with frequent lifting, carrying pushing, and pulling of objects weighing up to 10 pounds. Continuous walking and standing. Must be able to identify, match, and distinguish colors.

MMH provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetic, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.