Payer Enrollment and Contracting Specialist

PT Solutions Physical Therapy•,

4h•$60,000 - $70,000

About The Position

The Payer Enrollment and Contracting Specialist provides critical administrative support to ensure our PT Solutions therapists and clinics are properly contracted and enrolled with commercial and government health insurance plans. Additionally, they will act as a key support resource for the revenue cycle staff by proactively troubleshooting day-to-day issues to prevent reimbursement denials and optimize reimbursement.

Requirements

Knowledge of commercial and governmental reimbursement methodologies and payer contract terms.
Strong critical thinking and troubleshooting abilities to resolve payer contracting and enrollment obstacles independently.
Experience with professional credentialling and payer enrollment.
A service-oriented mindset with the ability to effectively support and collaborate with revenue cycle colleagues.
Strong verbal and written communication skills for professional interaction with clinical providers, revenue cycle leaders and insurance representatives.
High School Diploma or equivalent required.
5-7 years of experience in a healthcare administrative setting, ideally within payer contracting, provider enrollment, or revenue cycle operations.

Nice To Haves

Associate’s or bachelor’s degree in healthcare administration or a related field is a plus.
Experience with CAQH, PECOS and payer enrollment software is highly desirable.
Service in the military is highly desirable.

Responsibilities

Serve as a revenue cycle resource for payer contract and fee schedule information to address staff questions about reimbursement and network participation.
Navigate payer portals to research policies and procedures so that reimbursement problems may be resolved.
Organize payer contracts and fee schedules in the contract management database in a logical manner.
Assist with successful completion of initial enrollment and re-validation for Commercial, Governmental and Workers Compensation payers.
Serve as a liaison between clinic staff, revenue cycle and payer enrollment vendors to ensure timely payer enrollment.
Serve as a dedicated point of contact for patient access, billing and accounts receivable staff to address payer-related questions.
Resolve enrollment and payer contract related roadblocks affecting patient access and reimbursement.
Investigate and troubleshoot daily operational issues, such out of network status, incorrect payer/provider setups and system data mismatches.
Work closely with the Revenue Cycle team to research, analyze, and resolve claims denials specifically tied to enrollment or contracting errors.
Collaborate with Revenue Cycle team to identify and successfully resolve underpayments.
Update and maintain provider demographic data in internal systems and external databases.