Overview

The Payor Enrollment Specialist is responsible for provider enrollment into Federal, State, and commercial health plans, correspondence with provider's office, gathering of provider data needed for enrollment, completion of provider applications and follow-up with health plans until provider is fully enrolled. Also, responsible for advising the provider's office concerning best practices and procedures pertaining to enrollment.

Duties & Responsibilities

• Communicate & advise designated contact person of the paperwork necessary to begin the application process for new providers, including any necessary research to gather all details to appropriately enroll provider.
• Communicate & advise the provider or designated contact person of the sequential steps needed to begin the enrollment process, through completion and set timeline expectations.
• Maintain contact with designated contact person to obtain application signatures, and collect all required documents to include with the completed applications.
• Key all provider demographics & enrollment data into software system.
• Scan all related enrollment documents and applications into software system.
• Contact health plans to request provider enrollment application packages and/or required action for enrollment and continue follow-up with insurance plans by telephone or email until all provider numbers are issued.
• Prepare & distribute Payor Affiliation Reports and Status Notesto designated contact person(s) for each provider every 2-3 weeks in order to communicate the progress of approved provider numbers.
• Ability to interact positively in a team environment, demonstrating superior teamwork skills.
• Any other assigned responsibilities as requested by Supervisor, not specifically noted above.
• Prepare and submit monthly invoices in accounting software showing new work and completed work.

Skills Required

• Exceptional organizational abilities
• Strong verbal and written communication skills
• Positive and proactive attitude
• High attention to detail
• Effective critical thinking and problem-solving capabilities
• Proven ability to prioritize multiple projects and tasks
• Ability to exercise sound judgment
• Ability to work independently and manage assigned projects with minimal supervision
• Ability to manage time without immediate supervision
• Self-motivated and goal-oriented

Qualifications Required:

• Completion of 1–2 years of college coursework or equivalent professional experience.
• Prior payor enrollment experience preferred  
• Experience in Microsoft Office Suite, including Outlook, Excel (VLOOKUP), and Word, as well as experience with PDF tools such as Adobe Acrobat or Foxit.

Min

Max