Payor Enrollment Coordinator

Select Medical•Plano, TX

9d•Hybrid

About The Position

The Payor Enrollment Coordinator manages the non-delegated payor enrollment and re-credentialing process for providers, practitioners, and facilities. The role determines why claims are rejected and works with external payors and internal partners, including the Contracting department, to identify requirements and resolve issues. The coordinator reviews contracts for accuracy, completes and tracks credentialing and enrollment activity, and serves as a source of information about credentialing status. The position also maintains credentialing databases and payor portals with current provider and facility information. This is a full-time hybrid position in Plano, Texas, with a Monday–Friday schedule from 7:30 a.m. to 4:30 p.m. Central Time. Compensation is $20.00 per hour.

Requirements

At least 2 years of experience in the credentialing field or a related healthcare field.
Proficiency in Windows, including Word, Excel, and Access.
Ability to communicate assertively and professionally with internal and external partners to help find resolutions.
Strong oral and written communication skills and the ability to interact professionally and positively across all levels of the organization.
Attention to detail, good organizational skills, and the ability to maintain accuracy while meeting deadlines and production requirements.
Ability to work independently and collaboratively with a team.

Nice To Haves

Experience working in a hospital and/or with Medicare.
Experience in payor enrollment, facility enrollment, and Medicare/Medicaid.
Knowledge of credentialing processes, terminology, and NCQA standards.
Strong analytical skills, including process improvement and problem resolution.

Responsibilities

Manage all phases of the non-delegated payor enrollment process for providers and facilities.
Determine why claims are rejected and partner with external sources to identify the best resolution.
Partner with the Contracting department to determine payor credentialing requirements.
Develop working relationships with payors in an assigned territory and identify the appropriate questions and contacts for resolving issues.
Review contracting for accuracy and work with payors to ensure proper credentialing status.
Complete payor enrollment and re-credentialing for facilities and practitioners with applicable contracted, non-delegated payors.
Work with CVO Coordinators to collect payor enrollment requirements, including signature pages, state licenses, and proof of liability.
Complete and track health plan credentialing and enrollment for practitioners and facilities.
Serve as a company source of information about non-delegated payor credentialing activity status.
Maintain the credentialing database with relevant payor tracking and data.
Monitor provider and facility status in internal and external data systems related to non-delegated payor enrollment.
Maintain payor enrollment portals such as CAQH with current contact information, licensure effective dates, and certificate of liability data.