Payer Enrollment Specialist Full Time

Hughston Clinic • Columbus, GA

399d

About The Position

The Payer Enrollment Specialist is responsible for managing the onboarding, privileging, and licensing of providers, ensuring a smooth credentialing process. This role serves as the primary contact between the clinic, facilities, and medical boards, facilitating communication and processing requests related to payer enrollment.

Requirements

• One year of direct payor enrollment experience or three years of related credentialing experience in a large medical clinic/hospital setting or in a payor setting.
• High school graduate or equivalent.

Nice To Haves

• Advanced degree in related field.
• Provider Enrollment Specialist Certification (PESC).

Responsibilities

• Complete all initial payer enrollment applications for assigned payers.
• Complete and maintain all CAQH/PECOS profiles for all providers.
• Complete timely follow up on all payer enrollment applications.
• Complete and coordinate paperwork for ERA, EDI, EFT, and other electronic channels between the organization and payers in the electronic billing system, and with enrollment services.
• Ensure that payer e-credentialing and revalidations are completed timely to prevent any lapse in enrollment.
• Load and maintain enrollment approvals and effective dates in Athena and enrollment system timely.
• Communicate with payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the enrollment needs of the organization.
• Maintain knowledge of current health plan and agency requirements for credentialing/enrollments.
• Ensure practice addresses are current with government and commercial health plans, agencies and other entities by continuously updating rosters as payer directories.
• Maintain confidentiality of provider information.
• Terminate enrollment with government and commercial payers upon resignation or termination of providers.
• Update and maintain National Provider Identification files for providers.
• Use the electronic billing system, along with any of the organization's proprietary spreadsheets or software, as the primary source of immediate notification and maintenance of enrollment related data.
• Respond to the enrollment services dashboard tasks and overall maintenance and content.
• Monitor worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues and work towards resolution.
• Responsible for the day-to-day follow-ups for enrolled providers across Hughston's enterprise.

What This Job Offers

• Job Type: Full-time
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED