Payer Enrollment Specialist

Payer Enrollment Specialist

Fast Pace Health strives to provide a best in class patient experience in every interaction. We are seeking a highly-skilled, experienced Payer Enrollment Specialist to join our growing team. Our ideal candidate will be deeply committed to nurturing our Fast Pace mission of teamwork, communication, empowerment and quality care in a friendly and encouraging environment.

Fast Pace Health aims to push for a new vision of healthcare in rural communities that will consist of an array of different services. We are changing the delivery of healthcare in these rural areas by integrating excellent patient care, education, accessibility, and community service, in a way that puts the patient's needs first and improves the health status of our communities.

In a way, that best supports our values, the individual is responsible for the daily activities of credentialing and payor enrollment processes for Fast Pace. The Payer Enrollment Specialist will play an important role in leading, coordinating, monitoring, and maintaining the payer enrollment process. The Payer Enrollment Specialist facilitates all aspects of Fast Pace's credentialing, including initial provider enrollments, reassignments, and maintenance updates, as well as the enrolling of providers for health plan clients. The Payer Enrollment Specialist ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing and payer enrollment.

Why Choose Fast Pace Health?

Fast Pace Health is a growing company! You will have the support and mentoring you need to become the best Payer Enrollment Lead you can be! We will help you grow your clinical competencies, and can offer you a rewarding career path. We work as a dynamic team to surpass our business goals by ensuring our patients receive the best care possible in a positive environment.

We offer competitive compensation and benefits such as holiday pay, PTO, medical, dental, vision and work-life balance, to name a few.

As a Fast Pace Health employee you will have the opportunity to participate in community events and outreach programs. This includes, but is not limited to, seasonal parades, book drives, festivals, trunk or treating, fun runs, and more. We dress up for holidays and celebrate with pot lucks. At Fast Pace, our community is our family, and we are a family first community.

Responsibilities

Essential Functions:

1. Obtain, verify, analyze, and maintain all documentation required for provider, group, facility, and ancillary payer enrollments, ensuring accuracy and completeness prior to submission.
2. Coordinate and manage the payer enrollment lifecycle from initiation through approval, including application preparation, submission, follow-up, resolution of deficiencies, and final payer activation.
3. Prepare, submit, track, and maintain provider and organizational enrollments, revalidations, recredentialing applications, demographic updates, ownership changes, and provider roster submissions for commercial, Medicare, Medicaid, and other government payers.
4. Initiate payer contracting requests and collaborate with contracting to facilitate network participation.
5. Track all enrollment activities within CredentialStream ensuring documentation, status updates, milestones, and approvals are accurately recorded and maintained.
6. Maintain and continuously update payer-specific enrollment checklists, requirements, submission guidelines, and supporting documentation standards to ensure accurate first-pass submissions and reduce enrollment delays and denials.
7. Follow payer-specific enrollment checklists and established workflows to ensure applications are submitted accurately, completely, and within required turnaround times.
8. Conduct ongoing payer follow-up activities to resolve enrollment issues, obtain status updates, address deficiencies, and expedite approvals when necessary.
9. Interface directly with health plans, Medicare Administrative Contractors (MACs), Medicaid agencies, provider representatives, and payer relations contacts to support enrollment and credentialing activities.
10. Ensure ongoing accuracy, completeness, and maintenance of provider CAQH profiles, attestations, supporting documents, and related databases.
11. Coordinate CLIA certificate applications, renewals, updates, and maintenance activities for applicable locations.
12. Responsible for learning the aspects of compliance in the company by completing all mandatory compliance training
13. The ability to maintain friendly, cordial relations with all employees.
14. The ability to build and maintain confidence and credibility with all employees.
15. The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers.
16. The ability to perform the physical, use of senses, cognitive, and environmental functions of the position, as specified on the physical demands.
17. Ability to comply with Company standards of operations.
18. Ability to adhere to the Core Values of the Company, of teamwork, communication, empowerment, quality of care, and friendliness.

Supervisory Responsibilities: no direct reports

Hours Required: Full Time hourly position, overtime as approved by management

Experience Requirements and Preferences

Experience:

• Minimum of 4 years of progressive payer enrollment experience within a multi-location medical group or multi-specialty healthcare organization.
• Multi-state payer enrollment experience
• Demonstrated experience with:
• PECOS
• Medicaid and multi-state Medicaid enrollment
• Commercial payer enrollment
• Group and facility enrollments
• Payer revalidations
• EDI, ERA, and EFT enrollment processes
• Experience using payer enrollment and credentialing systems such as CredentialStream or similar.
• Experience utilizing payer portals including Availity, CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer portals.
• Waystar and Athena portal experience preferred.
• Experience initiating payer contracting and network participation requests preferred.
• Knowledge of payer enrollment regulations, enrollment lifecycle management and payer participation requirements.

Education Requirements

High School Diploma or Its Equivalent

Compliance

Fast Pace Health is committed to the principle of equal employment and creating an inclusive environment for the benefit of our employees, our patients, and our communities. We are an equal opportunity employer and welcome job applications from qualified individuals without regard to race, creed, color, ancestry, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, disability, veteran status, marital status, parental status, genetic information or any other legally protected characteristics or conduct. Please refer to the links below for information regarding your rights under certain federal laws:

Applicants are limited to individuals from states, excluding the following: California, Colorado, Hawaii, Illinois, New Jersey, New York, Rhode Island, Washington, and the District of Columbia.