Specialist-Payer Enrollment Senior

Baptist•Memphis, TN

About The Position

The Senior Payer Enrollment Specialist plays a pivotal role in safeguarding revenue integrity, supporting timely access to care, and ensuring full compliance with payer enrollment standards. This advanced position is responsible for managing complex and high-impact aspects of the enrollment process, including roster automation, data reconciliation, and escalated payer issues that may affect reimbursement or scheduling. In collaboration with leadership, the Senior Specialist evaluates and improves payer enrollment workflows to reduce delays, prevent revenue leakage, and enhance operational efficiency. Additionally, this role serves as a mentor and resource to the payer enrollment team, providing training and guidance to strengthen team performance and uphold quality standards across all enrollment functions.

Requirements

2 years focused credentialing and payer enrollment
Minimum: High school diploma/ GED and relevant combination of education and experience
Associates or bachelor’s in business, Finance, Health Care or related field

Nice To Haves

Supervisory or leadership experience desired

Responsibilities

Lead and manage the enrollment process for a portfolio of providers, which may include high-volume or complex cases. Oversee revalidation and re-enrollment processes for the portfolio of providers to ensure timely compliance.
Perform routine internal roster generation and reconciliation for payer enrollment through automated rosters.
Proactively monitor enrollment statuses to identify pending approvals, placing claim holds in system in conjunction with revenue cycle partners. Review payer approvals to release claim holds and review high-volume or high-impact claims on hold to prioritize internal enrollment follow-up and escalate to leadership as indicated.
Perform routine roster reconciliation and enrollment data validation across payer systems and internal platforms to ensure provider records are accurate, active, and current—mitigating risks of claim rejections, denials, or delayed payments.
Serve as a primary point of escalation for complex or time-sensitive enrollment issues, collaborating directly with payers and internal teams (e.g., billing, contracting, credentialing) to investigate and resolve discrepancies that may impact revenue or claim submissions.
Collaborate cross-functionally with credentialing, billing, provider relations, and compliance teams to align payer enrollment workflows with enterprise-wide data and operational standards.
Maintain expert-level knowledge of payer-specific enrollment rules, timelines, formats (e.g., rosters, CAQH, PECOS), and federal/state regulatory guidelines to ensure process adherence.
Build and maintain strong relationships with payer representatives, ensuring effective communication and problem resolution.
Prepare and present reports on enrollment metrics, trends, and challenges to leadership.
Ensure compliance with all payer enrollment documentation requirements and regulatory standards, conducting periodic audits, and providing recommendations for process enhancements.
Maintain accurate claims holds based off provider payer enrollment approvals. Ensuring release of claims of approved enrollments in a timely fashion.
Monitor and Resolve Enrollment-Related Claim Denials: Investigate and resolve claim denials or rejections related to provider enrollment issues, including missing or incorrect NPI, TIN, or payer ID information.
Maintain Accurate Provider Data: Ensure provider information is accurately reflected in payer systems to prevent claim processing delays or denials.
Follow Up with Payers: Communicate with insurance payers to verify provider enrollment status and resolve any issues affecting claims adjudication.