Payor Enrollment Specialist

Essential Duties and Responsibilities Payor Enrollment and Clearinghouse Management

• Initiate and manage payer enrollment applications through clearinghouses and insurer portals
• Coordinate enrollment for electronic claims submissions, electronic remittance, ERA, and electronic fund transfer (EFT), and eligibility transactions
• Maintain enrollment records and track application status through completion
• Follow up with insurance carriers and clearing houses regarding pending applications
• Resolve enrollment rejections, denials, and enrollment-related claim submission issues
• Maintain current enrollment relationship as Payer requirements change
• Serve as the primary liaison between US Neuro and Clearinghouse partners Monitor Payer enrollment report and identify missing and inactive connections
• Develop and maintain a master inventory of current payment enrollments

Gather and maintain required enrollment documentation, including:

• Provider NPIs
• Group NPIs
• Tax IDs
• W-9 forms
• Bank letters
• EFT documentation
• Authorized signatures
• Maintain accurate records of approvals, effective dates, and payer requirements.
• Ensure compliance with payer and clearing house policies

• High School diploma or equivalent
• 2+ years of health care payer enrollment, provider enrollment, credentialing, EDI, or revenue cycle experience
• Experience initiating payer enrollments through clearinghouses
• Understanding of ERA, EFT, EDI, and electronic claims processes
• Experience working with payer portals and insurance carrier websites
• Strong organizational and follow-up skills
• Ability to manage multiple enrollment projects simultaneously
• Proficiency with Microsoft Excel, Outlook, and health care software platforms

• Experience with Waystar, Availity, Office Ally, Change Healthcare, or similar clearinghouse platform
• Experience a medical biller or revenue cycle management
• Knowledge of commercial, Medicare, Medicaid, and managed care payer requirements.
• Experience with multi-state provider organizations.
• Experience supporting large-scale enrollment and conversion projects