The posting
JOB PURPOSE: The Payer Enrollment Specialist is responsible for coordinating, monitoring, and maintaining the provider and facility enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Assists with problem identification and timely resolution of payer related issues surrounding claim submission and denial management to ensure optimal reimbursement. Job Functions:
Completes and submits provider facility enrollment, revalidation reenrollment, and recredentialing applications to Medicare, Medicaid, commercial insurance carriers, and other third-party payors in accordance with payor-specific requirements. Monitors enrollment applications status, conduct follow-up with payors, and resolve application deficiencies to ensure timely approvals and prevent delays in provider participation and reimbursement. Maintains accurate provider and facility enrollment records, credentialing files, rosters, databases, and supporting documentation in compliance with organizational, regulatory, payor, and FQHC requirements Processes and submits provider and facility updates, including changes to demographics, practice locations, ownership, specialties, licensure, taxonomy, NPI, CAQH, and other enrollment-related information. Tracks revalidation, reenrollment, recredentialing, and document expiration deadlines to prevent enrollment lapses, claim denials, and interruptions in reimbursement. Coordinates with credentialing, medical staff, human resources, compliance, and provider onboarding, revenue cycle, and billing teams to facilitate timely provider enrollment and successful provider onboarding. Serves as the primary point of contact for payors, providers, and internal staff regarding enrollment inquiries, status updates, issue resolution, and enrollment-related requests Investigates and resolves enrollment discrepancies, and enrollment disconnects affecting providers and facilities. Maintains current knowledge of federal, state, Medicare, Medicaid, commercial payor, and managed care enrollment requirements and regulatory changes. Participates in continuous process improvement initiatives to enhance enrollment efficiency and effectiveness. Generates and maintains enrollment reports, approval tracking logs, performance metrics, and other data necessary to monitor enrollment Activities and organizational compliance.
Qualifications:
Minimum Qualifications
Details
Education
High School Diploma or G.E.D.
Experience
Two (2) years in Payer Enrollment role or equivalent healthcare insurance-related experience.
Fingerprint Clearance Card
Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.
Preferred Qualifications
Details
Experience
One (1) year of experience with a Federally Qualified Health Center.
Knowledge of Medicare, Medicaid, and commercial payor enrollment processes.
Bilingual (English/Spanish) with the ability to speak, read and write in both languages.
Transportation:
Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. El Rio Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors. All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive. El Rio Health is a Non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards.
