Specialist-Payer Enrollment

Job Summary

With direct impact on reimbursement timelines, patient satisfaction, and regulatory compliance, the Payer Enrollment Specialist plays a foundational role in healthcare administration. By ensuring timely and accurate enrollment of healthcare providers with commercial and government payers, this position directly contributes to the financial health of the organization and uninterrupted access to care for patients. Effective payer enrollment minimizes delays in reimbursement, supports provider scheduling, and ensures compliance with payer‑specific and regulatory requirements.

The specialist serves as a liaison between providers, internal departments, and payers to streamline application processing, manage revalidations, and resolve enrollment‑related issues. Attention to detail, understanding of credentialing standards, and proactive communication are essential for success in this role.

• Verify all required documentation for provider enrollment with insurance payers.
• Submit enrollment applications and documentation required for new providers, location adds, and practice changes.
• Maintain and update records of provider enrollment status, ensuring that all information is accurate and up‑to‑date.
• Complete timely revalidation through payer portals, recredentialing applications, or profiles such as CAQH.
• Follow up with payers to ensure timely and accurate processing of provider enrollments within payer‑specific turnaround time metrics.
• Monitor payer enrollment timelines and ensure that all required steps are completed in a timely manner to avoid delays in provider participation.
• Address provider inquiries regarding enrollment status, billing issues, or payer‑specific requirements.
• Coordinate with other internal departments (e.g., credentialing, billing) to ensure that enrollment information is aligned across systems.
• Research and maintain current knowledge of payer‑specific enrollment requirements and changes.
• Support the creation and maintenance of documentation for payer enrollment processes and procedures.
• Monitor and resolve enrollment‑related claim denials.
• Maintain accurate provider data.

2 years focused payer enrollment experience

• High School/GED
• Credentialing/Payer Enrollment certificate from an accredited facility.

Entry level

Other

Other

Hospitals and Health Care