Specialist, Payer Enrollment

Ovation Healthcare•Brentwood, TN

About The Position

The Payer Enrollment Specialist is responsible for supporting clients throughout the enrollment lifecycle and setup to ensure alignment with contractual and compliance requirements. This role is responsible for enrolling healthcare providers with commercial and government payers, ensuring timely credentialing and participation in insurance networks to ensure timely and accurate credentialing and participation in payer networks.

Requirements

Associate's or bachelor’s degree in healthcare administration, business, or related field preferred.
Minimum of 3 years of experience in provider enrollment, billing, credentialing, or client-facing healthcare services role.
Working knowledge of commercial and government insurance payers.
Proficiency in Microsoft Office Suite and credentialing/enrollment software systems (e.g., CAQH, PECOS, Availity).
Excellent communication and organizational skills with strong customer service.

Responsibilities

Manage the end-to-end provider enrollment process, including initial credentialing, recredentialing, revalidations, and payer contracting readiness.
Serve as a subject matter expert resource to clients on enrollment, best practices, and compliance requirements.
Prepare, complete, and submit enrollment for individual providers and healthcare facilities across a range of commercial and government payers, e.g., Medicare, Medicaid, private insurers.
Maintain accurate and up-to-date provider records, including CAQH profiles, NPI registration, state license verifications, and other required documentation.
Track enrollment status, renewal deadlines, and expirations; proactively follow up with payers to ensure timely processing and approvals
Communicate directly with clients, providers, payers, and internal teams to gather required documentation and resolve enrollment-related issues.
Update and maintain provider participation status within internal systems and credential databases.
Audit and maintain provider data in internal systems and credentialing databases- Stay current with changes in payer requirements, healthcare regulations, and credentialing standards; apply this knowledge to client recommendations and internal processes.
Prepare and deliver regular status updates, dashboards, and reports to clients and internal leadership.
Lead or assist in enrollment audits and implement corrective action plans as needed.