Payer Enrollment Specialist

Guidehouse•Birmingham, AL

3d•Onsite

About The Position

The Payer Enrollment Specialist is responsible for ensuring the timely and accurate enrollment of healthcare providers with major insurance vendors for a moderately sized medical group. This position manages payer enrollment functions and coordinates closely with the medical credentialing team for provider updates, resolves enrollment issues, and manages delegated provider rosters to ensure compliance with insurance payer requirements.

Requirements

High School Diploma or equivalent required.
1-3 years of experience in payer enrollment or a related role within healthcare billing or provider services.

Nice To Haves

Operational experience with MD-Staff or other payer enrollment software.
Experience with delegated roster management for insurance payers.

Responsibilities

Complete and manage payer applications for initial enrollment and re-enrollment, ensuring compliance with organizational standards and regulatory requirements.
Coordinate with insurance payers to maintain accurate provider enrollment records for both government and commercial payers.
Develop and distribute monthly delegated provider rosters, ensuring all provider status information remains current and accurate.
Work closely with the medical credentialing team to ensure seamless updates for provider enrollments and terminations.
Serve as a point of contact for payer enrollment inquiries and issues, providing timely support to both internal teams and external partners.
Proactively identify and resolve enrollment-related issues with insurance payers to minimize delays and maintain provider compliance.
Accurately enter, maintain, and update provider information in payer enrollment systems, following data standards.
Utilize MD-Staff or similar software to track application statuses and ensure timely follow-up on pending enrollment requests.
Regularly update tracking spreadsheets to monitor outstanding items, follow up as necessary, and provide enrollment reports to leadership and stakeholders.
Ensure all active providers are enrolled with relevant payers and submit timely updates for provider terminations or other changes.
Generate reports on enrollment progress, compliance, and delegated roster updates, sharing findings with internal stakeholders and recommending improvements as needed.
Complete all job-related duties as assigned to support the efficiency and success of the payer enrollment process.

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program