Payor Enrollment Specialist

Qualifications :

• Bachelor's degree in healthcare administration, business, or a related field. Master's degree is a plus.
• 2+ years of hands-on experience in roles related to provider licensing, credentialing, and payor enrollment.
• In-depth knowledge of state and federal regulations, accreditation standards, and payor requirements.
• Proficient in using credentialing and payor enrollment software.
• Strong organizational and project management skills to navigate multiple processes simultaneously.
• Effective communication and interpersonal skills for collaboration with internal teams and external stakeholders.
• Ability to contribute strategically to enhance the efficiency and effectiveness of processes

Job Overview :

As the Provider Licensing, Credentialing, and Payor Enrollment Specialist, you will be a pivotal contributor to the effective onboarding and integration of healthcare professionals within our organization.

This role involves managing the essential processes of provider licensing, credentialing, and payor enrollment, ensuring strict compliance with state and federal regulations.

You will collaborate closely with internal teams, coordinate with external entities, and address complex issues related to licensing and credentialing.

A thorough understanding of healthcare regulations, accreditation standards, and payor requirements is essential. Your attention to detail and expertise will be instrumental in fostering accurate and efficient processes, contributing to the success of our healthcare provider network.

Responsibilities : Provider Licensing :

Provider Licensing :

• Execute end-to-end licensing processes for healthcare providers, ensuring strict adherence to state and federal regulations.
• Stay updated on changes in healthcare laws and licensing requirements, implementing necessary process updates.
• Serve as a resource expert, offering guidance on intricate licensing issues and regulatory changes.
• Conduct meticulous reviews of provider license applications, ensuring accuracy and completeness.
• Collaborate with regulatory bodies and licensing agencies to resolve issues and expedite the licensing process.
• Manage and track the renewal process for provider licenses, ensuring timely renewals and compliance.

Credentialing :

• Drive the credentialing process for healthcare professionals, managing applications and verifications.
• Oversee a team dedicated to ensuring credentialing compliance with accreditation standards and payer requirements.
• Develop and implement efficient policies and procedures to optimize the credentialing process.
• Collaborate with internal teams to gather required documentation and information for credentialing.
• Address and resolve intricate issues related to credentialing, ensuring accuracy and completeness.

Payor Enrollment :

• Execute the provider enrollment process with various payors, ensuring accurate and timely submissions.
• Cultivate and maintain strong relationships with payors to facilitate seamless enrollment processes.
• Act as the primary point of contact for payor-related inquiries and issue resolution.
• Coordinate with internal departments to obtain necessary documentation and information for payor enrollment.
• Stay informed about changes in payor requirements and communicate updates effectively to the team.

We are an equal opportunity employer, and all qualified applicants will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by law. #LiveYourLife