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.
#J-18808-Ljbffr
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.
#J-18808-Ljbffr