Lead Payer Enrollment Coordinator - Full Time - Days

Mohawk Valley Health System•City of Utica, NY

6d•$23 - $34

About The Position

The Lead Payer Enrollment Coordinator coordinates provider credentialing and payer enrollment activities to ensure timely and accurate enrollment with contracted insurance carriers. This role assigns and monitors team workload, supports issue resolution, and collaborates with recruitment, medical staff, RCM, and operational leaders to prevent revenue disruption. The Coordinator ensures compliance with payer requirements, maintains accurate provider data in MDStaff and EPIC, and supports continuous improvement within the Provider Enrollment Department.

Requirements

High School Diploma or equivalent
5 years of healthcare provider credentialing/enrollment experience.
Experience with CAQH, NPPES, PECOS, and credentialing platforms.
Working knowledge of revenue cycle operations and payer enrollment structure.
Strong organizational, analytical, and problem-solving skills.
Excellent written and verbal communication abilities.
Proficiency in Microsoft Excel and credentialing systems.
Ability to manage multiple priorities in a fast-paced, team-oriented environment.
Commitment to confidentiality and data accuracy.

Responsibilities

Coordinate and assign all new provider enrollments and provider changes to the Credentialing Team, ensuring balanced workload distribution and timely completion.
Mentors and supports onboarding of new credentialing staff and junior staff; provides training and guidance on best practices.
Serve as primary escalation point for complex provider and payer enrollment issues; communicate trends and barriers to the Provider Enrollment Manager.
Collaborate with provider recruitment, medical staff, RCM, contracting, and operational leadership to support onboarding, facility enrollments, and prevent revenue delays.
Monitor provider enrollment status across all carriers, ensuring accurate updates and documentation templates in MDStaff, enrollment tables in EPIC, and internal tracking tools.
Communicates, at least monthly, with health plans (more if needed) to obtain statuses of providers and to address any claims issues including holds and denials.
Ensure timely submission of new provider enrollments, facility applications, revalidations, terminations, roster updates, panel changes, and collaborating physician documentation.
Lead enrollment activities for specialty programs including Residency NPIs and taxonomy updates, and physician extender requirements.
Generate and distribute enrollment status reports and analyze denial trends to proactively address payer issues.
Maintain working knowledge of payer policies, regulatory requirements, and credentialing platforms including CAQH, PECOS, and NPPES.
Support process improvement initiatives and assist in development of departmental policies and procedures.
Attend recruitment and payer meetings as required.
Perform other duties as assigned.