Payer Enrollment Specialist

at  DCH Health System

Overview:
Payer Enrollment Specialist will be responsible for managing and optimizing the hospital’s payer enrollment processes, including but not limited to initial enrollment, revalidations, and other miscellaneous tasks as required by payers. This role involves ensuring accurate and timely enrollment with various payers, maintaining compliance, and collaborating with internal teams to enhance financial performance

Responsibilities:

• Facilitate the enrollment and credentialing process with various payers, including government programs and private insurers.
• Maintain up-to-date knowledge of payer regulations, guidelines, and requirements to ensure compliance.
• Collaborate with internal stakeholders, including billing and coding teams, to resolve payer-related issues and streamline processes.
• Perform thorough verification and validation of provider information to prevent enrollment delays and billing errors.
• Stay informed about changes in healthcare policies, reimbursement rates, and coding standards that may impact payer enrollment.
• Develop and maintain strong relationships with payer representatives to expedite and troubleshoot enrollment processes.
• Generate reports and analyze data related to payer enrollment, providing insights to improve efficiency and revenue outcomes.
• Participate in training sessions and workshops to enhance knowledge and skills related to payer enrollment and healthcare regulations.

PHYSICAL FACTORS

• The Americans with Disabilities Act (ADA) requires the job description to document physical factors, including ability, activities, and requirements.
• Ability: Gross Body Equilibrium and Coordination.
• Activities: Talking, hearing, walking, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls.
• Requirements: Please indicate the physical requirements of the job as one of the following:
• Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
• Must be able to perform the duties with or without reasonable accommodation.
• Hearing and vision must be normal or corrected to within normal range.
• Physical presence onsite is essential.

• Facilitate the enrollment and credentialing process with various payers, including government programs and private insurers.
• Maintain up-to-date knowledge of payer regulations, guidelines, and requirements to ensure compliance.
• Collaborate with internal stakeholders, including billing and coding teams, to resolve payer-related issues and streamline processes.
• Perform thorough verification and validation of provider information to prevent enrollment delays and billing errors.
• Stay informed about changes in healthcare policies, reimbursement rates, and coding standards that may impact payer enrollment.
• Develop and maintain strong relationships with payer representatives to expedite and troubleshoot enrollment processes.
• Generate reports and analyze data related to payer enrollment, providing insights to improve efficiency and revenue outcomes.
• Participate in training sessions and workshops to enhance knowledge and skills related to payer enrollment and healthcare regulations