Payer Enrollment Specialist

NEUROMONITORING ASSOCIATES LLC•McKinney, TX

2d•Remote

About The Position

The Payer Enrollment Specialist serves as the operational link between NMA’s payer strategy (in-network and out-of-network) and the organization’s ability to submit claims, support accurate adjudication, and receive reimbursement. This role is responsible for payer enrollment and participation activities associated with managed care agreements and other payer arrangements, including provider and group enrollment, Letters of Agreement (LOAs), roster submissions, and provider-to-group affiliations following contract execution.

Requirements

High school diploma or equivalent required
5+ years of experience in payer enrollment, provider enrollment, or managed care operations with direct payer portal experience.
Experience managing high volume provider enrollment workflows, including roster management and participation maintenance.
Working knowledge of provider enrollment systems and payer platforms, including CAQH ProView, PECOS, and major payer portals.
Experience supporting both in network and out of network payer relationships.
Experience supporting hospital based professional services (e.g., IONM, anesthesia, radiology).
Experience managing provider enrollment across multistate environments.
Experience managing IDTF enrollment and participation requirements.
Strong attention to detail, follow up discipline, and deadline management.
Proficiency in Excel for tracking and managing provider and enrollment data.
Ability to work independently, investigate issues, identify root cause, and drive resolution.
Knowledge of billing participation requirements for hospital based or supervision dependent services, including place of service and component considerations.
Ability to maintain stationary position for extended periods.
Occasionally required to move short to moderate distances.
Must be able to lift and/or move up to 50 pounds occasionally.

Nice To Haves

Associate's or Bachelor's degree in healthcare administration, business, or a related field preferred
Relevant credentialing or provider enrollment experience may substitute for formal education
CPMSM - Certified Provider Medical Services Management preferred
CPCS - Certified Provider Credentialing Specialist preferred

Responsibilities

Serve as the enrollment implementation lead for in-network participation with commercial and government payers.
Manage post execution payer enrollment and participation activities, including provider and group enrollment, roster submissions, and provider to group affiliation requirements.
Ensure payer participation status supports accurate billing and reimbursement under applicable networks and products.
Manage operational execution for out of network payer participation, including setup and maintenance of Letters of Agreement and other payer specific arrangements.
Serve as the primary point of contact for resolving out of network participation issues that impact claims processing or reimbursement.
Manage provider to payer affiliation activities, including roster management, provider demographic updates, and payer attestation requirements.
Maintain participation continuity for individual providers and groups to support uninterrupted billing and reimbursement.
Manage government payer enrollment and participation activities, including Medicare, Medicaid, and other applicable programs
Oversee enrollment maintenance and revalidation requirements to ensure continuous participation and compliance with program deadlines
Manage payer enrollment and participation requirements specific to Intraoperative Neuromonitoring (IONM) services.
Collaborate with billing and revenue cycle teams to ensure payer participation supports compliant billing and reimbursement within hospital-based care environments
Monitor payer directories and network listings to ensure accurate provider participation status and network representation.
Identify and address directory inaccuracies or network issues, including silent PPO or rental network arrangements, that impact reimbursement.
Maintain accurate provider and organizational enrollment data across payer and regulatory systems to support participation and reimbursement.
Manage payer required documentation and electronic payment enrollment activities in coordination with internal teams.
Investigate and resolve reimbursement issues attributable to payer enrollment or participation status, coordinating with payer representatives as needed.
Serve as the escalation point for enrollment related issues impacting claims processing, providing participation guidance to billing and revenue cycle teams.