Payer Enrollment Specialist
NMA (Neuromonitoring Associates), Mckinney, Texas, United States, 75069
Payer Enrollment Specialist
Fully Remote
McKinney, TX 75070 Overview
Level: Entry Position Type: Full Time Education Level: High School Category: Admin - Clerical Description
Position Title: Payer Enrollment Specialist Department: Operations Reports To: Director of Revenue Strategy & Efficiency FLSA: Non-Exempt Position Summary: The Payer Enrollment Specialist serves as the operational link between NMA's payer strategy (in-network and out-of-network) and the organization's ability to submit claims, support accurate adjudication, and receive reimbursement. This role is responsible for payer enrollment and participation activities associated with managed care agreements and other payer arrangements, including provider and group enrollment, Letters of Agreement (LOAs), roster submissions, and provider-to-group affiliations following contract execution. Essential Duties & Responsibilities: In-Network Enrollment, Participation & Contract Execution: Serve as the enrollment implementation lead for in-network participation with commercial and government payers. Manage post execution payer enrollment and participation activities, including provider and group enrollment, roster submissions, and provider to group affiliation requirements. Ensure payer participation status supports accurate billing and reimbursement under applicable networks and products. Out-of-Network (OON) Participation Support & Payer Relationship Maintenance: Manage operational execution for out of network payer participation, including setup and maintenance of Letters of Agreement and other payer specific arrangements. Serve as the primary point of contact for resolving out of network participation issues that impact claims processing or reimbursement. Provider-to-Payer Affiliation (NPI/TIN Linking, Rostering, Attestation): Manage provider to payer affiliation activities, including roster management, provider demographic updates, and payer attestation requirements. Maintain participation continuity for individual providers and groups to support uninterrupted billing and reimbursement. Government Enrollment (Medicare/Medicaid/DOL): Manage government payer enrollment and participation activities, including Medicare, Medicaid, and other applicable programs Oversee enrollment maintenance and revalidation requirements to ensure continuous participation and compliance with program deadlines IONM-Specific Enrollment and Participation Requirements: Manage payer enrollment and participation requirements specific to Intraoperative Neuromonitoring (IONM) services. Collaborate with billing and revenue cycle teams to ensure payer participation supports compliant billing and reimbursement within hospital-based care environments Directory Audits, Network Integrity & Silent PPO Prevention: Monitor payer directories and network listings to ensure accurate provider participation status and network representation. Identify and address directory inaccuracies or network issues, including silent PPO or rental network arrangements, that impact reimbursement. Payer Portal Management, Data Integrity & Documentation: Maintain accurate provider and organizational enrollment data across payer and regulatory systems to support participation and reimbursement. Manage payer required documentation and electronic payment enrollment activities in coordination with internal teams. Troubleshooting & Denial Prevention: Investigate and resolve reimbursement issues attributable to payer enrollment or participation status, coordinating with payer representatives as needed. Serve as the escalation point for enrollment related issues impacting claims processing, providing participation guidance to billing and revenue cycle teams. Qualifications
Qualifications & Requirements: Education Licenses/Certifications: High school diploma or equivalent required Associate's or Bachelor's degree in healthcare administration, business, or a related field preferred Relevant credentialing or provider enrollment experience may substitute for formal education CPMS - Certified Provider Medical Services Management preferred CPCS - Certified Provider Credentialing Specialist preferred Experience: 5+ years of experience in payer enrollment, provider enrollment, or managed care operations with direct payer portal experience. Experience managing high volume provider enrollment workflows, including roster management and participation maintenance. Working knowledge of provider enrollment systems and payer platforms, including CAQH ProView, PECOS, and major payer portals. Experience supporting both in network and out of network payer relationships. Experience supporting hospital based professional services (e.g., IONM, anesthesia, radiology). Experience managing provider enrollment across multistate environments. Experience managing IDTF enrollment and participation requirements. Skills & Competencies: Strong attention to detail, follow up discipline, and deadline management. Proficiency in Excel for tracking and managing provider and enrollment data. Ability to work independently, investigate issues, identify root cause, and drive resolution. Knowledge of billing participation requirements for hospital based or supervision dependent services, including place of service and component considerations. Working Conditions: Generally, work in a remote environment. Frequent and prolonged periods of computer and office equipment usage. Standard business hours with occasional overtime to meet project deadlines. Ability to manage stress and maintain productivity under tight deadlines and changing priorities. Regular interaction with team members, clients, and other stakeholders through various communication channels. Occasional travel required for company meetings. Physical Demands: Ability to maintain stationary position for extended periods. Occasionally required to move short to moderate distances. Must be able to lift and/or move up to 50 pounds occasionally. Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Employees must be able to perform the essential functions of the position satisfactorily. Furthermore, the statements do not establish a contract for employment and are subject to change at the discretion of the Company with or without advance notice.
Fully Remote
McKinney, TX 75070 Overview
Level: Entry Position Type: Full Time Education Level: High School Category: Admin - Clerical Description
Position Title: Payer Enrollment Specialist Department: Operations Reports To: Director of Revenue Strategy & Efficiency FLSA: Non-Exempt Position Summary: The Payer Enrollment Specialist serves as the operational link between NMA's payer strategy (in-network and out-of-network) and the organization's ability to submit claims, support accurate adjudication, and receive reimbursement. This role is responsible for payer enrollment and participation activities associated with managed care agreements and other payer arrangements, including provider and group enrollment, Letters of Agreement (LOAs), roster submissions, and provider-to-group affiliations following contract execution. Essential Duties & Responsibilities: In-Network Enrollment, Participation & Contract Execution: Serve as the enrollment implementation lead for in-network participation with commercial and government payers. Manage post execution payer enrollment and participation activities, including provider and group enrollment, roster submissions, and provider to group affiliation requirements. Ensure payer participation status supports accurate billing and reimbursement under applicable networks and products. Out-of-Network (OON) Participation Support & Payer Relationship Maintenance: Manage operational execution for out of network payer participation, including setup and maintenance of Letters of Agreement and other payer specific arrangements. Serve as the primary point of contact for resolving out of network participation issues that impact claims processing or reimbursement. Provider-to-Payer Affiliation (NPI/TIN Linking, Rostering, Attestation): Manage provider to payer affiliation activities, including roster management, provider demographic updates, and payer attestation requirements. Maintain participation continuity for individual providers and groups to support uninterrupted billing and reimbursement. Government Enrollment (Medicare/Medicaid/DOL): Manage government payer enrollment and participation activities, including Medicare, Medicaid, and other applicable programs Oversee enrollment maintenance and revalidation requirements to ensure continuous participation and compliance with program deadlines IONM-Specific Enrollment and Participation Requirements: Manage payer enrollment and participation requirements specific to Intraoperative Neuromonitoring (IONM) services. Collaborate with billing and revenue cycle teams to ensure payer participation supports compliant billing and reimbursement within hospital-based care environments Directory Audits, Network Integrity & Silent PPO Prevention: Monitor payer directories and network listings to ensure accurate provider participation status and network representation. Identify and address directory inaccuracies or network issues, including silent PPO or rental network arrangements, that impact reimbursement. Payer Portal Management, Data Integrity & Documentation: Maintain accurate provider and organizational enrollment data across payer and regulatory systems to support participation and reimbursement. Manage payer required documentation and electronic payment enrollment activities in coordination with internal teams. Troubleshooting & Denial Prevention: Investigate and resolve reimbursement issues attributable to payer enrollment or participation status, coordinating with payer representatives as needed. Serve as the escalation point for enrollment related issues impacting claims processing, providing participation guidance to billing and revenue cycle teams. Qualifications
Qualifications & Requirements: Education Licenses/Certifications: High school diploma or equivalent required Associate's or Bachelor's degree in healthcare administration, business, or a related field preferred Relevant credentialing or provider enrollment experience may substitute for formal education CPMS - Certified Provider Medical Services Management preferred CPCS - Certified Provider Credentialing Specialist preferred Experience: 5+ years of experience in payer enrollment, provider enrollment, or managed care operations with direct payer portal experience. Experience managing high volume provider enrollment workflows, including roster management and participation maintenance. Working knowledge of provider enrollment systems and payer platforms, including CAQH ProView, PECOS, and major payer portals. Experience supporting both in network and out of network payer relationships. Experience supporting hospital based professional services (e.g., IONM, anesthesia, radiology). Experience managing provider enrollment across multistate environments. Experience managing IDTF enrollment and participation requirements. Skills & Competencies: Strong attention to detail, follow up discipline, and deadline management. Proficiency in Excel for tracking and managing provider and enrollment data. Ability to work independently, investigate issues, identify root cause, and drive resolution. Knowledge of billing participation requirements for hospital based or supervision dependent services, including place of service and component considerations. Working Conditions: Generally, work in a remote environment. Frequent and prolonged periods of computer and office equipment usage. Standard business hours with occasional overtime to meet project deadlines. Ability to manage stress and maintain productivity under tight deadlines and changing priorities. Regular interaction with team members, clients, and other stakeholders through various communication channels. Occasional travel required for company meetings. Physical Demands: Ability to maintain stationary position for extended periods. Occasionally required to move short to moderate distances. Must be able to lift and/or move up to 50 pounds occasionally. Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Employees must be able to perform the essential functions of the position satisfactorily. Furthermore, the statements do not establish a contract for employment and are subject to change at the discretion of the Company with or without advance notice.