Payer Enrollment Specialist
Payer Enrollment Specialist
Qualifacts- Posted 10 hours ago
- Be among the first 10 applicants
Job Description
Job Description
EDI Enrollment Management:
EDI Enrollment Management:
- Prepare, submit, monitor, and maintain EDI enrollment requests for electronic transactions, including:
- Electronic Claims (837)
- Electronic Remittance Advice (ERA/835)
- Electronic Funds Transfer (EFT)
- Claim Status transactions (276/277), where applicable
- Eligibility transactions (270/271), where applicable
- Complete payer-specific electronic enrollment applications through payer portals, clearinghouses, and paper enrollment processes, as required.
- Coordinate EDI enrollments with clearinghouses and insurance payers to establish electronic connectivity for assigned providers and client groups.
- Validate provider demographic information, National Provider Identifier (NPI), Tax Identification Number (TIN), billing information, and banking details before submission to ensure enrollment accuracy.
- Track enrollment status, payer responses, effective dates, approvals, and activation milestones through completion.
- Perform timely follow-up with insurance payers and clearinghouses to obtain enrollment status, resolve deficiencies, and expedite approvals.
- Investigate and resolve rejected, delayed, or incomplete EDI enrollment requests.
- Escalate aging enrollments, payer delays, or connectivity issues that may impact claims submission or payment processing.
- Maintain consistent communication with internal stakeholders regarding enrollment progress, risks, and expected completion timelines.
- Maintain accurate documentation within enrollment systems, work queues, trackers, CMD records, and document repositories.
- Document payer communications, enrollment approvals, rejection reasons, and corrective actions in accordance with RCMS documentation standards.
- Ensure all enrollment records are complete, current, and audit-ready.
- Safeguard sensitive provider and banking information while adhering to HIPAA and organizational security requirements.
- Partner with Credentialing, Billing, AR, Payment Posting, Client Success, Implementations, and U.S.-based teams to support provider onboarding and revenue cycle readiness.
- Coordinate with internal departments to resolve enrollment dependencies affecting electronic claims submission or payment processing.
- Support new client implementations, provider onboarding, and organizational growth initiatives by ensuring timely EDI setup.
- Identify process improvement opportunities to reduce enrollment turnaround times, improve first-pass approval rates, and standardize EDI workflows.
- Assist in training team members and sharing payer-specific EDI enrollment knowledge and best practices.
More Info
Job Type:
Industry:
Employment Type:
Key Skills
Electronic Funds Transfer EFT
Tax Identification Number (TIN)
EDI enrollment
RCMS documentation standards
National Provider Identifier (NPI)
Electronic Claims 837
Electronic Remittance Advice ERA 835
Clearinghouses
Payer portals
About Company
Skills:
U.S. healthcare EDI enrollment processes, Microsoft Excel, clearinghouse platforms, enrollment tracking systems, 837 Electronic Claims, analytical and troubleshooting skills, major clearinghouses and payer portals, HIPAA electronic transaction standards, commercial Medicare Medicaid and managed care payer electronic enrollment processes