Consultant, Payor Enrollment

Munson Healthcare • Traverse City, MI

1d

About The Position

Lead and coordinate all payor enrollment activities, ensuring timely submissions, approvals, and maintenance of active provider enrollments. Serve as the primary escalation point for complex enrollment and credentialing issues, partnering with health plans to resolve challenges and implement solutions.

Monitor enrollment operations, including status updates, team inquiries, audits, KPI reporting, and final review of payer submissions. Collaborate with credentialing, onboarding, revenue cycle, and operational teams to support provider onboarding, enrollment compliance, and resolution of enrollment-related denials and underpayments.

Requirements

• Bachelor’s degree required.
• At least five years of experience in physician services, revenue cycle, or another healthcare-related field required.
• Knowledge of payor requirements required.

Nice To Haves

• Three years of management or leadership experience preferred.
• Knowledge of NCQA credentialing standards preferred.
• Ability to interpret data within computerized information systems preferred.

Responsibilities

• Lead and coordinate payor enrollment activities, ensuring timely submissions, approvals, and maintenance of active provider enrollments.
• Serve as the primary escalation point for complex enrollment and credentialing issues.
• Partner with health plans to resolve enrollment challenges and implement solutions.
• Monitor enrollment operations, including status updates, team inquiries, audits, KPI reporting, and final review of payer submissions.
• Collaborate with credentialing, onboarding, revenue cycle, and operational teams to support provider onboarding and enrollment compliance.
• Support resolution of enrollment-related denials and underpayments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level