Payer Enrollment Specialist

Somnia Anesthesia - New Rochelle, NY (30+ days ago)4.0


A healthcare services company located in Westchester County, NY is seeking an experienced credentialing leader. This position involves working with clients and major insurance companies throughout the country.

RESPONSIBILITIES

  • Identify, create and maintain payment enrollment process for new or existing clients for both managed care organizations (MCOs) and government payers.
  • Manage payment enrollment process for clinicians practicing in inpatient and outpatient settings. Ensures applications are submitted with all supporting documentation as required by the client or MCO to allow for timely credentialing.
  • Prepare and produce correspondence to clients, clinicians, MCOs and government payers.
  • Enroll clinical personnel into MCOs Medicare and Medicaid (DCC).
  • Develop and maintain effective enrollment contacts with clients and MCOs nationally.
  • Work with offshore team to facilitate enrollment process.
  • Maintain and prepare enrollment packets by state and ensure all applications are the latest version.
  • Perform regular and routine follow-up with clients and payers on the status of clinician enrollment applications.
  • Produce weekly follow up reports on all credentialing activities.
  • Assist with Claims resolution as necessary.
  • Identify and update internal departments of changes in client, MCO and government policy and procedures and enrollment related processes.
  • Perform database audits.
  • Perform special projects and related duties, as required.

DESIRED SKILLS & EXPERIENCE

  • Bachelor’s degree preferred or equivalent experience
  • Minimum 2 years provider enrollment experience with large group practice, hospital or management company preferred
  • Knowledge of the commercial health insurance industry, industry practices and government payers.
  • CACTUS database experience minimum 1 yr preferred
  • Ability to work independently, multi-task and handle a heavy work load in a fast-paced environment
  • Strong decision-making and problem solving skills
  • Strong written and verbal communication skills
  • Strong computer skills
  • Excellent organizational skills a must