Guidehouse
healthcare
PayerEnrollmentSpecialist
Neural analysis suggests this role is
optimal for Entry candidates.
“Payer Enrollment Specialist at Guidehouse. Skills: payer enrollment, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement. Complete and manage payer applications for initial enrollment and re-enrollment, ensuring compliance with organizational standards and regulatory requirements.. Coordinate with insurance payers to maintain accurate provider enrollment records for both government and commercial payers.”
What You'll Achieve.
ensuring the timely and accurate enrollment of healthcare providers with major insurance vendors; ensure compliance with insurance payer requirements; ensure seamless updates for provider enrollments and terminations; minimize delays and maintain provider compliance; ensure timely follow-up on pending enrollment requests; support the efficiency and success of the payer enrollment process
Industry & Context.
resolves enrollment issues; Proactively identify and resolve enrollment-related issues with insurance payers to minimize delays and maintain provider compliance.
100% Onsite, Travel Required: None, Clearance Required: None
What They're Looking For.
Must Have
1-3 years of experience in payer enrollment or a related role within healthcare billing or provider services
Nice to Have
Operational experience with MD-Staff or other payer enrollment software, Experience with delegated roster management for insurance payers
What You'll Do.
Complete and manage payer applications for initial enrollment and re-enrollment
ensuring compliance with organizational standards and regulatory requirements.
Coordinate with insurance payers to maintain accurate provider enrollment records for both government and commercial payers.
Develop and distribute monthly delegated provider rosters
ensuring all provider status information remains current and accurate.
Work closely with the medical credentialing team to ensure seamless updates for provider enrollments and terminations.
Serve as a point of contact for payer enrollment inquiries and issues
providing timely support to both internal teams and external partners.
Proactively identify and resolve enrollment-related issues with insurance payers to minimize delays and maintain provider compliance.
and update provider information in payer enrollment systems
following data standards.
Utilize MD-Staff or similar software to track application statuses and ensure timely follow-up on pending enrollment requests.
Regularly update tracking spreadsheets to monitor outstanding items
follow up as necessary
and provide enrollment reports to leadership and stakeholders.
Ensure all active providers are enrolled with relevant payers and submit timely updates for provider terminations or other changes.
Generate reports on enrollment progress
and delegated roster updates
sharing findings with internal stakeholders and recommending improvements as needed.
Complete all job-related duties as assigned to support the efficiency and success of the payer enrollment process.
How You'll Work.
Team & Collaboration
coordinates closely with the medical credentialing team; Serve as a point of contact for payer enrollment inquiries and issues, providing timely support to both internal teams and external partners.; sharing findings with internal stakeholders
Communication Scope
Serve as a point of contact for payer enrollment inquiries and issues
Full Job Description
**_Job Family_ :** Patient Account Representative Credentials ** _Travel Required_ :** None ** _Clearance Required_ :** None The Payer Enrollment Specialist is responsible for ensuring the timely and accurate enrollment of healthcare providers with major insurance vendors for a moderately sized medical group. This position manages payer enrollment functions and coordinates closely with the medical credentialing team for provider updates, resolves enrollment issues, and manages delegated provider rosters to ensure compliance with insurance payer requirements. **Position Type:** Full Time, Days, 100% Onsite **Schedule:** Monday - Friday, 8:00am - 5:00pm **Location:** UAB Avondale Business Office ** _What You Will Do_****:** _Payer Enrollment and Compliance:_ * Complete and manage payer applications for initial enrollment and re-enrollment, ensuring compliance with organizational standards and regulatory requirements. * Coordinate with insurance payers to maintain accurate provider enrollment records for both government and commercial payers. * Develop and distribute monthly delegated provider rosters, ensuring all provider status information remains current and accurate. _Collaboration and Issue Resolution:_ * Work closely with the medical credentialing team to ensure seamless updates for provider enrollments and terminations. * Serve as a point of contact for payer enrollment inquiries and issues, providing timely support to both internal teams and external partners. * Proactively identify and resolve enrollment-related issues with insurance payers to minimize delays and maintain provider compliance. _Data and Enrollment Management:_ * Accurately enter, maintain, and update provider information in payer enrollment systems, following data standards. * Utilize MD-Staff or similar software to track application statuses and ensure timely follow-up on pending enrollment requests. * Regularly update tracking spreadsheets to monitor outstanding items, follow up as necessary
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