Payor Enrollment Specialist

Harbin Clinic • Rome, GA

99d

About The Position

The position involves managing provider records and enrollment processes within the practice management system. The individual will be responsible for maintaining participation with various managed care organizations, Medicaid, and Medicare services. The role requires collaboration with insurance carriers and internal teams to resolve issues related to payer questions and claims billing. The candidate will also be tasked with maintaining documentation and reporting on provider enrollments, ensuring compliance with specific application requirements for each payer, and providing status reports to management.

Requirements

• A minimum of three to five years of relevant work experience in payer enrollment, credentialing, or claims billing/follow up required
• Proficiency in Athena practice management highly preferred
• Must possess or be willing to develop general knowledge of CAQH, PECOS, and credentialing systems

Responsibilities

• Create provider records in the practice management system
• Manage and complete provider enrollment applications
• Maintain participation with managed care organizations as defined by Payer Contracting
• Maintain participation with Medicaid and Medicare services including MA and CMO plans
• Facilitate claims billing by maintaining payer assigned privileges and billing numbers in the practice management system
• Maintain enrollment dashboard and payer enrollment table within practice management system
• Complete electronic remittance advice (ERA) enrollments and prepare electronic funds transfer (EFT) documents for CFO signature
• Collaborate with various insurance carriers, internal and external team members to resolve payer questions and issues
• Maintain documentation and reporting regarding provider enrollments in process within the credentialing database
• Responsible for understanding specific application requirements for each payer including pre-requisites, forms required, licensure, CLIA, supporting documentation and regulations
• Research payer enrollment guidelines as needed for non-contracted payers
• Provide enrollment status reports to management and key personnel
• Responsible for claims follow up for denials and edits related to payer enrollment
• Maintain referring provider billing table
• Maintain DEA license within the practice management system
• Set up departments in practice management
• Enter department numbers in the practice management systems

What This Job Offers

• Industry: Ambulatory Health Care Services
• Number of Employees: 1,001-5,000 employees