Healthcare Payer Enrollment Coordinator

Division/Department: RCS/Payer Operations and Intelligence

Job Title: Payer Enrollment Coordinator

Range: $60k-$70k depending on experience

Summary:The Payer Operations and Intelligence Payer Enrollment Coordinator is integral in coordinating successful payer enrollment activities for internal and external clients. This individual will establish, maintain, and communicate payer enrollment strategies, status, and tasks with clients & internal stakeholders, while further managing & reporting on the status of deliverables critical to completing payer enrollment. Furthermore, this individual will serve as a point person for continuing enrollment education & process awareness throughout the Revenue Cycle Services (“RCS”) division, ensuring appropriate tools are maximized. The role is part of a tactical team that maintains a strong knowledge of the Company’s complete claim, remittance, eligibility, and claim status capabilities, ensuring each is effectively deployed, maintained and supported across the RCS customer base for operational and reimbursement efficiency. Proactive monitoring of payer and industry happenings is also expected to ensure Company awareness of the ever-evolving payer enrollment landscape. Direct collaboration with Clients, Client Services, Production Operations, Marketing, payers, and Company’s EDI division is expected, thus strong verbal and written communication is key.

Key Responsibilities:

• Collaborate with clients to ensure their enrollment needs are serviced. This would include, but not be limited to, leading strategic enrollment meetings upon client implementation to educate and provide guidance in the eligibility setup space. Weekly reporting on enrollment trackers and regular meetings with the client would also be required.
• Representing the Payer Operations and Intelligence Team in the New Client Implementation process. Delivering professional presentations, outlining the payer enrollment process and services, directly to the Client and external/internal stakeholders.
• Work with direct manager to create and disseminate a corporate enrollment document portfolio including enrollment process flows and educational material.
• Manage and administer provider enrollment for electronic claims, remittance and eligibility on behalf of customers, collaborating directly with Client Services and customers on payer specific progress.
• Collaborate directly with Company’s EDI division on the administration of EDI payer enrollment changes, ensuring effective communication is administered across the
• Company and applicable forms are completed as necessary.
• Proactively assess electronic claim and remittance setup opportunities across the RCS customer base, executing upon immediate opportunities as warranted through collaboration with Client Service and Production Operations, while further advancing RCS electronic interests with the Company’s EDI division.
• Proactively assess healthcare enrollment regulations, trends, and applicable compliance items through payer and industry publications, facilitating informative communication across Client Services, Production Operations, customers, and Marketing as applicable.
• Actively participate in the Company’s monthly Insurance Committee meeting and other internal EDI meetings, ensuring that the RCS division’s interests are appropriately represented, while further ensuring applicable meeting detail is communicated across the division.
• Resolve enrollment support events for internal and external customers by means of leveraging internal and payer resources, while further orchestrating communication and corrective activities.
• Provide subject matter expertise to Client Services and Production Operations on enrollment transactions, acting as a liaison with the Company’s EDI division.
• Other duties, as assigned.

Education / Experience:

• Bachelor degree in Healthcare, Business or equivalent experience preferred.
• Professional with excellent communication, analytical, and time management skills.
• Detail oriented with strong organizational and multi-tasking skills
• Advanced in Microsoft Office applications
• Ability to assess task priorities and work independently
• Experience in the electronic enrollment landscape considered a plus
• Experience with one of more of Quadax’s revenue cycle management applications (HARP, PAS, Xpeditor) considered a plus
• Experience with medical billing (CMS1500, UB04) considered plus