Payor Enrollment Manager

The Payor Enrollment Manager is responsible for completing applications and enrolling clinical

providers in commercial, governmental and other insurance payer programs. Familiarity with PECOS, CAQH and payer portals is preferred.

You will work with the providers to complete all necessary information required to submit their initial application as well as any renewals that may be required.

Strong organizational and communication skills are necessary to ensure timely and accurate processing of applications as well as supporting our clinical and client staff.

Job responsibilities include, but are not limited to:

Complete and submit initial payer enrollment applications for commercial and government payers.

• Complete and maintain CAQH profiles.

• Timely follow up on payer enrollment applications

• Complete and coordinate initial paperwork for ERA, EDI, EFT

• Work with payer portal web sites

• Process re-credentialing and revalidations timely to prevent any lapse in enrollment.

• Maintain enrollment and billing information in the billing/Credentialing systems

• Communicate with hospitals, payers, providers, and other entities as needed to assist in the enrollment process.

• Maintain knowledge of current health plan and agency requirements for enrollment.

• Maintain confidentiality of provider information.

• Terminate enrollment with payers upon termination of providers.

• Monitor enrollment worklists to track enrollment status and held claims status

Qualifications, Skills and Knowledge Required:

• High School degree with preferred 3 years' experience in a payer enrollment or healthcare insurance related field

• Knowledge of healthcare billing systems (athenahealth preferred)

• Excellent written and oral communication skills

• Must be comfortable working with Excel and Word

• Strong organizational, problem solving and decision-making skills

• Ability to prioritize and manage multiple projects

• Self-motivated who can work independently

• Strong attention to detail and follow up

• Ability to work with others in collaborative role

Keywords

• Payor Enrollment

• CAQH

• Medicare/Medicaid

• Healthcare Billing

• Insurance physician enrollment

THIS IS AN IN-OFFICE POSITION, NO REMOTE WORK AVAILABLE.

Job Type: Full-time