Provider Network Associate - Payor Contracting

On Belay Health Solutions

15h

About The Position

We are seeking a detail-oriented and organized Provider Network Associate - Payor Contracting to join our team. This role is essential for managing the enrollment process and maintaining accurate provider roster information for payor and government programs. Your primary focus will be on ensuring accurate and up-to-date records, facilitating communication between internal teams and payor partners, and assisting in compliance efforts. This position is vital for optimizing our provider network and enhancing operational and financial efficiency for payor contracts.

Requirements

3+ years of experience in provider enrollment, roster management, value-based and government programs.
Superior understanding of healthcare regulations, credentialing processes, and enrollment requirements for payor and government programs.
Excellent organizational skills with a strong attention to detail and accuracy
Strong verbal and written communication skills, with the ability to collaborate effectively with cross-functional teams.

Nice To Haves

Bachelor’s degree in Healthcare Administration, Business, or a related field
ACO, MSO experience
Multi-State or National payor experience
Strong knowledge of healthcare reimbursement methodologies and value-based payment models.

Responsibilities

Facilitate the enrollment of healthcare providers in various payor and government programs, including Medicare, Medicaid, Medicare Advantage and Commercial payors.
Prepare and submit enrollment applications, ensuring all documentation is complete and compliant with payor requirements.
Track the progress of enrollment applications and follow up as necessary to ensure timely processing.
Maintain and update the provider roster for all contracted payors and government programs, ensuring accuracy and compliance with policies.
Conduct regular audits of provider data to verify completeness, including licenses, certifications, and demographic information.
Assist in onboarding and training new staff and/or providers on provider enrollment processes, compliance requirements, and best practices.
Generate reports on enrollment status and roster metrics to assist in compliance monitoring and decision-making.
Prepare for audits by maintaining organized and accurate documentation of enrollment and roster records.
Work closely with credentialing, contracting, and billing teams to gather necessary information and resolve discrepancies related to provider enrollment.
Develops and enforces best practices for provider data management, helping to standardize processes across the organization.
Provides insights through regular reporting on provider enrollment status, compliance metrics, and roster accuracy, aiding in strategic decision-making.
Act as the primary liaison for payors regarding enrollment inquiries and status updates. Communicate any changes in provider status, additions, or terminations as required.
Serve as the primary point of contact for providers regarding enrollment and roster management inquiries, providing timely and accurate information.
Identify opportunities for streamlining enrollment and roster management processes and implement best practices to enhance efficiency and accuracy.
Address issues related to provider enrollment, such as discrepancies in documentation or changes in provider status, ensuring timely resolution.
Perform other duties as assigned.