Payer Enrollments

Allied Digestive Health•West Long Branch, NJ

2d•$30 - $37•Onsite

About The Position

The Payer Enrollments position is responsible for coordinating with vendors to manage provider enrollment, re-enrollment, and revalidation applications with various third-party payers. This role involves monitoring enrollment status, maintaining accurate provider data, managing roster updates, and resolving enrollment-related issues to ensure compliance and efficient operations within the Credentialing Department.

Requirements

Strong verbal and written communication skills.
Excellent organizational skills and attention to detail.
Ability to manage multiple tasks and prioritize work effectively.
Strong problem-solving and follow-up skills.
Ability to work independently and collaboratively in a fast-paced environment.
Professional demeanor with strong customer service skills.
Proficiency with Microsoft Office Suite, particularly Excel.
Willingness to learn healthcare credentialing systems and payer portals.
2+ years of healthcare payer enrollment, credentialing, revenue cycle, or related healthcare administration experience.
Prior healthcare office, administrative, internship, or customer service experience required.
Knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
Experience with credentialing, revenue cycle, or medical office operations.

Nice To Haves

Associate's or bachelor's degree preferred.
CPMSM, CPCS, CPES, or related industry certification is preferred but not required.

Responsibilities

Coordinate with vendor to prepare, submit, and track provider enrollment, re-enrollment, and revalidation applications with commercial, Medicare, Medicaid, and other third-party payers.
Monitor enrollment status and follow up with payers to ensure timely processing and approval.
Maintain accurate provider demographic, licensure, credentialing, and enrollment data within internal systems.
Coordinate meetings with health plans and/or funders.
Manage provider roster updates, contract participation changes, terminations, and practice location additions or closures.
Research and resolve enrollment-related claim denials and reimbursement issues.
Ensure compliance with payer requirements, regulatory standards, and organizational policies.
Generate enrollment status reports and communicate progress to stakeholders.
Serve as a subject matter expert regarding payer enrollment processes and requirements.
Utilize credentialing and practice management software.
Provide administrative support to the Credentialing Department as needed.
Maintain confidentiality of sensitive provider and organizational information.