Payer Enrollment Assistant

ESSENTIAL FUNCTIONS: Provider & Facility Enrollment: Prepare, complete, submit, and process initial and ongoing enrollment applications for healthcare providers and facilities with Medicare, Medicaid, commercial insurance plans, and other third-party payers.

Application Tracking: Maintain accurate and detailed records of enrollment applications, including submission dates, application status, payer communications, approval dates, effective dates, and recredentialing deadlines.

Weekly Payer Follow-Up: Proactively contact insurance payers at least weekly to obtain status updates, resolve outstanding issues, and ensure timely processing of enrollment applications.

Recredentialing & Renewals: Monitor upcoming recredentialing and reenrollment deadlines and complete required applications and documentation to prevent lapses in participation.

Documentation Management: Gather, verify, organize, and maintain required provider and facility documentation, including licenses, certifications, malpractice insurance, NPI information, and other enrollment requirements.

Database Maintenance: Maintain accurate provider information in CAQH, PECOS, payer portals, and internal tracking systems, as applicable.

Problem Resolution: Identify enrollment delays, missing information, or discrepancies and work proactively with payers and internal departments to resolve issues.

Internal Communication: Collaborate with Human Resources, Revenue Cycle, Finance, and clinical leadership to support timely enrollment of new providers, facility changes, and ongoing payer participation.

Reporting: Provide regular updates on pending applications, outstanding issues, approaching deadlines, and completed enrollments.

Compliance: Ensure enrollment information is accurate, complete, and maintained in accordance with payer requirements and applicable regulations.