Payor Enrollment Specialist

Job Description

Job Description

Description:

US Neuro is a seeking Payer Enrollment Specialist to manage and expand our payment enrollment footprint throughout all clearinghouse and electronic claim systems. This position will be responsible for obtaining, tracking, and maintaining enrollment with commercial, government, and managed care insurance carriers to ensure efficient electronic claims submission, eligibility verification, and payment processing. 

Essential Duties and Responsibilities 

Payor Enrollment and Clearinghouse Management

• Initiate and manage payer enrollment applications through clearinghouses and insurer portals 
• Coordinate enrollment for electronic claims submissions, electronic remittance, ERA, and electronic fund transfer (EFT), and eligibility transactions
• Maintain enrollment records and track application status through completion 
• Follow up with insurance carriers and clearing houses regarding pending applications 
• Resolve enrollment rejections, denials, and enrollment-related claim submission issues 
• Maintain current enrollment relationship as Payer requirements change 
• Serve as the primary liaison between US Neuro and Clearinghouse partners Monitor Payer enrollment report and identify missing and inactive connections 
• Develop and maintain a master inventory of current payment enrollments 

Documentation and Compliance 

Gather and maintain required enrollment documentation, including:  

• Provider NPIs
• Group NPIs
• Tax IDs
• W-9 forms
• Bank letters
• EFT documentation
• Authorized signatures
• Maintain accurate records of approvals, effective dates, and payer requirements. 
• Ensure compliance with payer and clearing house policies 

Required Qualifications 

• High School diploma or equivalent
• 2+ years of health care payer enrollment, provider enrollment, credentialing, EDI, or revenue cycle experience
• Experience initiating payer enrollments through clearinghouses
• Understanding of ERA, EFT, EDI, and electronic claims processes
• Experience working with payer portals and insurance carrier websites
• Strong organizational and follow-up skills
• Ability to manage multiple enrollment projects simultaneously
• Proficiency with Microsoft Excel, Outlook, and health care software platforms

  Preferred Qualifications 

• Experience with Waystar, Availity, Office Ally, Change Healthcare, or similar clearinghouse platform 
• Experience a medical biller or revenue cycle management 
• Knowledge of commercial, Medicare, Medicaid, and managed care payer requirements.
• Experience with multi-state provider organizations. 
• Experience supporting large-scale enrollment and conversion projects