Facility Enrollment Specialist

Main Street Family Care
Birmingham, AL | Full Time | In-Person

Main Street Family Care operates almost 70urgent care clinics across Alabama, Georgia, Florida, and North Carolina, with a focus on expanding access to quality healthcare in underserved and rural communities. We're growing - and we're building the team to do it right.

The Facility Enrollment Specialist is responsible for managing and maintaining payer enrollment, credentialing, recredentialing, and related administrative requirements for the organization’s clinic locations. This position serves as the primary resource for facility-level payer enrollment and ensures that clinic locations remain properly enrolled and credentialed with Medicare, Medicaid, commercial insurance carriers, and other applicable health plans. This role works closely with Revenue Cycle Management, Provider Credentialing, Billing, Operations, and other internal teams to address payer enrollment issues that could affect a clinic’s ability to bill and receive reimbursement.

• Manage initial payer enrollment and credentialing for new clinic locations.
• Manage recredentialing and revalidation requirements for existing clinic locations.
• Complete and submit facility-level enrollment applications for Medicare, Medicare DME, Medicaid, commercial payers, managed care organizations, and other health plans.
• Add new clinic locations to existing payer contracts and organizational/group enrollments as appropriate.
• Maintain facility demographic and enrollment information with payers, including addresses, tax identification numbers, NPIs, billing information, ownership information, and other required data.
• Manage payer enrollment changes associated with clinic openings, relocations, acquisitions, ownership changes, closures, and other organizational changes.
• Track enrollment applications through completion and perform timely follow-up with payers.
• Maintain accurate records of facility enrollment effective dates, renewal/revalidation dates, payer participation, and application status.
• Ensure required facility documentation remains current and available for payer enrollment and recredentialing.

• Serve as an authorized administrator for applicable payer websites, enrollment systems, and insurance portals.
• Establish and maintain organizational access to payer portals and manage appropriate administrative permissions.
• Serve as a primary point of contact for facility-specific payer enrollment and credentialing matters.
• Research and resolve payer issues related to facility enrollment, participation status, demographic information, or payer records.
• Coordinate with payer representatives to resolve enrollment discrepancies and outstanding application requirements.
• Maintain knowledge of payer-specific enrollment requirements and communicate significant changes to appropriate internal stakeholders.

• Coordinate payer updates related to facility licenses, CLIA certificates, accreditation, Medicare/Medicare DME enrollment, Medicaid enrollment, and other applicable facility credentials.
• Monitor expiration and renewal dates for documentation required to maintain payer enrollment.
• Assist with payer enrollment activities associated with changes in facility licensure, service offerings, laboratory status, ownership, or organizational structure.
• Support enrollment and credentialing activities associated with acquisitions and organizational expansion into new locations or markets.
• Maintain organized documentation to support payer audits, enrollment verification, and recredentialing activities.

• Partner with Revenue Cycle Management and Billing teams to investigate facility-level enrollment issues that may impact claims processing or reimbursement.
• Research payer enrollment issues associated with claim denials, non-participating status, incorrect location information, or effective-date discrepancies.
• Escalate payer enrollment barriers that could materially impact revenue or clinic operations.
• Provide enrollment status and effective-date information to internal teams as needed.
• Coordinate with Provider Credentialing when payer requirements involve both individual practitioners and clinic locations.

• Coordinate payer enrollment activities for new clinic openings.
• Develop and maintain payer enrollment timelines for new locations to support operational readiness.
• Assist with…