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Job Description
Role: Payer Enrollment Specialist Location: Remote Duration: through end of 2026 Pay Rate: $20.79/hour W2
Our client is seeking a detail-oriented and proactive Payer Enrollment Specialist who thrives in a fast-paced, compliance-driven environment and takes ownership of critical payer enrollment and revalidation processes. This role is responsible for managing provider enrollment with commercial payers ensuring accurate and timely submission of applications, tracking approvals, and maintaining continuous participation across all contracted networks.
The Payer Enrollment Specialist will oversee the full enrollment lifecycle, including initial enrollments, re-credentialing/revalidations, demographic updates, roster submissions, and payer communications. This role requires strong follow-through, cross-functional collaboration, and the ability to manage multiple timelines while maintaining compliance with payer requirements and internal standards.
Balancing operational precision with provider support, this individual will serve as a key liaison between providers, payers, credentialing, contracting, and billing teams to ensure seamless onboarding and uninterrupted revenue cycle operations.
Responsibilities - Manage the end-to-end payer enrollment process for individual and group providers with commercial plans.
- Prepare, submit, and track enrollment applications through CAQH, PECOS, state Medicaid portals, and proprietary payer systems.
- Monitor application statuses, proactively follow up with payers, and resolve enrollment delays or discrepancies.
- Oversee revalidations, re-credentialing, demographic updates, EFT/ERA enrollments, and roster submissions to prevent participation lapses.
- Maintain accurate provider enrollment records within internal systems and ensure alignment with credentialing and contracting data.
- Respond to provider inquiries related to payer participation, effective dates, billing readiness, and enrollment requirements.
- Communicate directly with payers to troubleshoot issues, clarify documentation requirements, and escalate concerns when necessary.
- Collaborate cross-functionally with Credentialing, Contracting, Revenue Cycle, Billing, and Provider Success teams to ensure providers are enrollment-complete and revenue-ready.
- Identify and implement process improvements to enhance efficiency, reduce processing times, and improve provider experience.
- Maintain compliance with federal and state regulations, payer-specific guidelines, and internal audit standards.
Qualifications - Bachelor’s degree preferred (or equivalent work experience).
- 2+ years of payer enrollment experience in a healthcare organization, medical group, health plan, hospital, CVO, or behavioral health setting.
- Strong knowledge of CAQH, NPPES, and commercial payer enrollment processes.
- Experience managing roster submissions preferred.
- Experience working with enrollment tracking systems, Salesforce, Zendesk, credentialing platforms, or similar tools.
- Exceptional attention to detail and ability to manage multiple concurrent enrollments with competing deadlines.
- Strong written and verbal communication skills, with the ability to build trust and maintain professional relationships with providers and payer representatives.
- Self-starter who proactively identifies issues, researches solutions, and drives processes to completion.
- Comfortable working in a highly collaborative, cross-functional environment.
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