Payer Enrollment & Administration Manager

ODYSSEY BEHAVIORAL GROUP•Franklin, TN

About The Position

The Manager of Payer Enrollment & Administration centralizes responsibility for facility enrollment, directory management, contract administration, and revenue cycle escalation support. Ensure consistent internal management of payer-facing operational processes, improves contract and enrollment visibility, and supports revenue cycle performance through coordinated payer engagement.

Requirements

Position requires a bachelor’s degree in Business Administration or Healthcare Administration and two (2) years of directly related experience.

Responsibilities

Serves as the central coordinator for facility enrollment with managed care organizations across all locations.
Manages enrollment for new facilities and market expansion initiatives.
Coordinates re-enrollment or renegotiation cycles.
Facilitates completion of enrollment documentation with internal stakeholders.
Maintains communication with payers regarding enrollment status and requirements.
Maintains accurate and compliant payer directories.
Conducts routine payer directory audits across all contracted plans.
Identifies and resolves discrepancies, enhancing referral identification.
Facilitates the completion and record keeping of all required directory attestations.
Coordinates with payers to make directory corrections, ensuring accurate network access information is readily available to prospective clients and referral sources.
Develops and maintains internal infrastructure for managing facility enrollment and credentialing information in a reportable, scalable, and transparent manner.
Maintains facility enrollment data in a structured, accessible, scalable, and reportable format.
Organizes and manages supporting documentation for centralized retrieval.
Maintains NPPES profiles for all facilities.
Establishes standardized processes for document management and reporting.
Provides operational support for contract administration, management, and documentation; improving internal organization and visibility to contract terms and rates.
Maintains the payer contract database with a high level of accuracy.
Loads new contracts, amendments, and rate renewals; archives historic data for future retrieval, if needed.
Supports internal reporting requests related to contracts and rates, as needed and requested.
Assists with the resolution of complex payer-related revenue cycle issues; improving collections and reducing leakage through proactive management of payer disputes.
Facilitates resolution of high-dollar, high-volume, and/or high-profile claims issues.
Engages payers to address previously denied claims and pursue payment resolutions.
Coordinates with finance leadership, CFOs, and revenue cycle teams to gather supporting documentation.
Maintains the RCM issue tracking database for finance leadership visibility.
Escalates matters requiring legal review to the VP of Payor Relations & Reimbursement.