Sr Payer Enrollment Systems Administrator

Full-Time - Revenue Cycle Billing Operations

Summa's Corporate Office

Summa Health System is recognized as one of the region’s top employers by a number of third party organizations, including North Coast 99. Exceptional candidates gravitate to Summa because of its culture, passion for delivering excellent service to our patients and families commitment to our philosophy of servant leadership, collegial working relationships at every level of the organization and competitive pay and benefits.

Acts as both the strategic lead for provider enrollment operations and the designated system administrator for Summa Health's credentialing, enrollment software platforms, and Medicare administrative portals. Responsible for overseeing complex network enrollment processes, managing primary source verification databases, and auditing system data to maximize electronic billing efficiency while simultaneously preventing revenue leakage across all hospital TINs and NPIs. In addition to day-to-day strategic enrollment operations, this position serves as the designated administrator for Medicare Provider Enrollment (PECOS), the HIPAA Eligibility Transaction System (HETS) EDI enrollment, and the My CGS Medicare Administrative Contractor portal.

Will be the point person from Revenue Cycle to support the organization's compliance efforts related to new CMS mandates including the HETS NPI attestation requirement and provider-based NPI attestation requirements for off-campus outpatient departments.

• Formal
  
  Education Required:
• Bachelor's degree in Business Administration, Healthcare Administration, Health Information Management, or a related field.
• In lieu of a Bachelor's degree, Associate's degree with a minimum of two (2) years of progressive payer enrollment experience may be considered. Bachelor's degree is strongly preferred.
• Experience & Training
  
  Required:
• Five (5) years of progressive payer enrollment and credentialing experience in a hospital system or large healthcare organization required; 7+ years preferred.
• Demonstrated hands‑on experience as a system administrator or super user for credentialing and enrollment software platforms.
• Demonstrated hands‑on experience working directly in Medicare PECOS including new enrollments, change‑of‑information submissions, revalidations, and multi‑TIN management.
• Experience managing payer enrollment across multiple Tax  simultaneously.
• Experience with HETS EDI enrollment and/or HETS trading partner agreements strongly preferred.
• Experience with My CGS or a comparable MAC portal (e.g., Novitasphere, WPS Portal) preferred.
• Experience developing enrollment policies, procedures, and KPI frameworks for large groups or health systems.
• Experience managing payer enrollment through a Tax , acquisition, or merger strongly preferred.
• Experience with Ohio Medicaid PNM provider enrollment system preferred.
• Familiarity with Epic Revenue Cycle payer setup, EDI enrollment workflows, and payer table configuration a plus.
• Other Skills, Competencies and
  
  Qualifications:
• In‑depth understanding of Medicare enrollment regulations, CMS‑855 forms, NPPES/NPI requirements, primary source verification standards, and provider‑based attestation rules.
• Advanced proficiency with online payer enrollment tools including Availity, payer‑specific enrollment portals, Tricare, and Medicaid enrollment systems; working knowledge of EDI transaction standards (270/271, 835, 837).
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and Adobe Acrobat Professional.
• Demonstrated ability to develop and track KPIs, conduct Revenue Cycle audits, analyze denial trends, and drive process improvements to reduce write‑offs and claim denials.
• Strong…