Job description

Job Summary:
The Payor Enrollment Specialist oversees the process to enroll groups and providers with insurance payors. The individual in this role is responsible for ensuring that all group and provider information is accurate and maintained with all insurance payers and databases to ensure that payments are received.
All Healogics employees must perform their job responsibilities according to all Healogics policies, Hospital policies, as well as to accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services (CMS) guidelines, as applicable.

Essential Functions/Responsibilities:
• Coordinate Provider on-boarding related to payor enrolment
• Communicate payor turn-around times to the Credentialing Manager
• Group and provider payor enrolment credentialing and re-credentialing
• Complete group and provider applications, and obtain signatures
• Troubleshoot and resolve payer issues related to enrolment/credentialing
• Alert payors of terminated providers
• Review first collection report with new Program Directors
• Maintain group and provider demographics on various databases that insurance carriers access for enrolment and payment
• Maintain Insurance payor Grid by Group and provider and communicate to the Credentialing Manager
• Communicates and works directly with insurance carriers, providers, and other third parties, fostering positive relationships and partnerships.
• Verification of provider status with Insurance Payors
• Performs other duties as required

Required Education, Experience and Credentials:
• High School Diploma is required
• Minimum of 3 years related experience in provider enrollment and/or credentialing for a professional group practice

Required Knowledge, Skills and Abilities:
• Strong written and verbal communication and interpersonal skills
• Impeccable attention to detail
• Ability to efficiently manage quickly-changing priorities in a busy work environment
• Proficient with Microsoft Office programs and can navigate spreadsheets, presentations, and documents
• Takes initiative to identify and resolve problems
• Adaptable to change
• Ability to contribute as a team player
• Maintains confidentiality

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