Payer Enrollment Specialist
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Job Description
Payer Enrollment Specialist managing healthcare provider enrollment with government and commercial insurers for Guidehouse. Maintaining payer records, delegated rosters, compliance, and enrollment reporting.
Responsibilities:
- Complete and manage payer applications for initial enrollment and re-enrollment
- Ensure compliance with organizational standards and regulatory requirements
- Coordinate with insurance payers to maintain accurate provider enrollment records for government and commercial payers
- Develop and distribute monthly delegated provider rosters
- Collaborate with the medical credentialing team on provider enrollments and terminations
- Serve as a point of contact for payer enrollment inquiries and issues
- Identify and resolve enrollment-related issues with insurance payers
- Enter, maintain, and update provider information in payer enrollment systems
- Use MD-Staff or similar software to track application statuses and follow up on pending requests
- Update tracking spreadsheets and provide enrollment reports to leadership and stakeholders
- Ensure active providers are enrolled with relevant payers
- Submit timely updates for provider terminations and other changes
- Generate reports on enrollment progress, compliance, and delegated roster updates
- Recommend process improvements and complete assigned duties supporting payer enrollment operations
Requirements:
- High School Diploma / GED or 3 years of relevant equivalent experience in lieu of Diploma / GED
- 1-3+ year's experience in office, business, operations, customer service or healthcare field
- Operational experience with MD-Staff or other payer enrollment software
- Experience with delegated roster management for insurance payers
Benefits:
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Flexible benefits package
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