Payor Enrollment Specialist

PAYOR ENROLLMENT SPECIALIST

Job Description

Department: Payor Enrollment/Credentialing

Reports To: Director of Business Administration

Location : Onsite
Employment Status: Full-Time

Employment Type: Hourly

Level: Entry-level 

Travel Required: No

Job Summary

The Payor Enrollment Specialist is responsible for obtaining, maintaining, and managing provider and organizational enrollments with commercial insurance carriers, government payers, managed care organizations, and electronic clearinghouses. This position ensures timely enrollment for claims submission, electronic remittance advice (ERA), electronic funds transfer (EFT), eligibility verification, and other electronic transactions essential to reimbursement operations.

The Payor Enrollment Specialist serves as the primary liaison between US Neuro, insurance carriers, clearinghouses, and internal stakeholders to ensure uninterrupted claims processing and payment workflows. The role requires strong attention to detail, effective project management, and a thorough understanding of healthcare revenue cycle operations.

US Neuro Expectations

• Comply with all US Neuro policies, procedures, and confidentiality requirements.
• Consistently demonstrate US Neuro’s core values through professional conduct and ethical behavior.
• Maintain a positive, respectful, and professional attitude in all interactions with patients, colleagues, clients, and business partners.
• Communicate effectively and regularly with immediate supervisors regarding responsibilities, priorities, and any workplace concerns.
• Report to work on time, prepared, and ready to fulfill all assigned job duties.
• Meet established productivity, quality, and performance standards while adapting to changing workload demands.
• Safeguard patient information and manage all records in strict compliance with HIPAA regulations and company policies.
• Ensure accurate, timely, and complete data entry, documentation, and record maintenance.
• Foster a collaborative work environment by working positively and effectively with team members across all departments.
• Demonstrate accountability, reliability, and a commitment to supporting organizational goals and delivering exceptional service.

Key Responsibilities

Payor Enrollment Management

• Initiate, complete, and submit enrollment applications for commercial, Medicare, Medicaid, and managed care payers.
• Coordinate provider, group, facility, and organizational enrollments with insurance carriers.
• Maintain active enrollment status with all contracted payers.
• Monitor enrollment application progress and follow up on pending requests.
• Resolve enrollment rejections, delays, and discrepancies.
• Ensure timely completion of revalidations, credentialing-related enrollments, and payer updates. 

Clearinghouse and EDI Management

• Manage payer enrollments through clearinghouse platforms.
• Coordinate setup and maintenance of: 
• Electronic Claims Submission
• Electronic Remittance Advice (ERA)
• Electronic Funds Transfer (EFT)
• Eligibility Verification Transactions
• Monitor clearinghouse reports and identify inactive or missing payer connections.
• Work with payers and clearinghouse partners to troubleshoot EDI-related issues. 

Documentation and Compliance

• Collect, maintain, and organize required enrollment documentation, including: 
• Provider NPIs
• Group NPIs
• Tax Identification Numbers
• W-9 Forms
• Bank Letters
• EFT Documentation
• Licenses and Certifications
• Authorized Signatures
• Maintain accurate records of enrollment approvals, effective dates, and payer-specific requirements.
• Ensure compliance with payer regulations and organizational standards. 

Revenue Cycle Support

• Partner with Billing, Credentialing, Contracting, and Finance teams to support reimbursement operations.
• Identify enrollment issues impacting claims submission or payment processing.
• Assist in resolving payer enrollment-related claim denials.
• Support new provider onboarding and facility acquisitions by coordinating enrollment activities.
• Maintain a master inventory of all active payer enrollments and electronic transactions. 

Reporting and Monitoring

• Track enrollment metrics and project status.
• Maintain enrollment databases and tracking tools.
• Generate reports on: 
• Enrollment status
• Pending applications
• Payer participation
• EFT and ERA implementation
• Revalidation deadlines
• Communicate enrollment updates to management and operational teams.

Required Qualifications

• High School Diploma or equivalent required.
• Minimum two (2) years of healthcare payer enrollment, provider enrollment, credentialing, EDI, or revenue cycle experience.
• Experience working with insurance carrier portals and enrollment applications.
• Understanding of: 
• ERA
• EFT
• EDI Transactions
• Electronic Claims Processing
• Strong organizational and project management skills.
• Ability to manage multiple enrollment projects simultaneously.
• Intermediate to advanced Microsoft Excel and Outlook skills. 

Preferred Qualifications

• Experience with: 
• Waystar
• Availity
• Office Ally
• Change Healthcare
• Similar Clearinghouse Platforms
• Knowledge of Medicare, Medicaid, Commercial, and Managed Care payer requirements.
• Experience in multi-state healthcare organizations.
• Revenue Cycle Management experience

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