Payer Relations Specialist
StationMD, Maplewood, NJ, United States
StationMD is a telehealth company dedicated to serving individuals with intellectual and/or developmental disabilities (I/DD). All StationMD clinicians are board-certified and specially trained to treat individuals with I/DD. Clinicians are available 24/7 via telemedicine for urgent and non-urgent medical matters. StationMD also offers scheduled psychiatry visits via telemedicine to individuals with I/DD. In providing this suite of services, StationMD enables individuals with I/DD faster access to high-quality care and substantially reduces unnecessary medical costs.
Position Summary We are seeking a Payer Relations Credentialing Associate to assist with the process of enrolling healthcare providers with insurance companies, re-credentialing, updating databases, and problem-solving enrollment issues to ensure timely and accurate network participation.
Responsibilities
Application Management:
Prepare and submit initial and renewal credentialing/enrollment applications for providers (physicians, facilities, etc.) with commercial and government payers.
Follow-Up:
Proactively track and follow up on application statuses, ensuring timely processing and resolving delays.
Data Management:
Maintain accurate provider data within internal and external protocols and databases for contracted and non-contracted payers.
Liaison:
Serve as a contact for providers, internal teams, and insurance companies regarding credentialing and enrollment.
Compliance:
Ensure adherence to payer requirements, policies, and regulatory standards.
Issue Resolution:
Troubleshoot contracting processing issues by collaborating cross functionally to develop solutions.
Monitoring:
Track provider licenses, certifications, and insurance expirations.
Qualifications
Associate’s degree or equivalent experience in healthcare or business administration
Minimum of 4 years of credentialing and payer enrollment experience
Strong understanding of health insurance payors and reimbursement processes
Experience with credentialing/payor enrollment tracking software (Medallion or similar system)
Excellent written and verbal communication skills
Strong organizational and follow-up skills
Ability to analyze data and identify trends
Excellent attention to detail and accuracy
Energy and passion for increasing access to quality healthcare and improving the quality of life for individuals with Intellectual and Developmental Disabilities
StationMD is an equal opportunity employer.
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Position Summary We are seeking a Payer Relations Credentialing Associate to assist with the process of enrolling healthcare providers with insurance companies, re-credentialing, updating databases, and problem-solving enrollment issues to ensure timely and accurate network participation.
Responsibilities
Application Management:
Prepare and submit initial and renewal credentialing/enrollment applications for providers (physicians, facilities, etc.) with commercial and government payers.
Follow-Up:
Proactively track and follow up on application statuses, ensuring timely processing and resolving delays.
Data Management:
Maintain accurate provider data within internal and external protocols and databases for contracted and non-contracted payers.
Liaison:
Serve as a contact for providers, internal teams, and insurance companies regarding credentialing and enrollment.
Compliance:
Ensure adherence to payer requirements, policies, and regulatory standards.
Issue Resolution:
Troubleshoot contracting processing issues by collaborating cross functionally to develop solutions.
Monitoring:
Track provider licenses, certifications, and insurance expirations.
Qualifications
Associate’s degree or equivalent experience in healthcare or business administration
Minimum of 4 years of credentialing and payer enrollment experience
Strong understanding of health insurance payors and reimbursement processes
Experience with credentialing/payor enrollment tracking software (Medallion or similar system)
Excellent written and verbal communication skills
Strong organizational and follow-up skills
Ability to analyze data and identify trends
Excellent attention to detail and accuracy
Energy and passion for increasing access to quality healthcare and improving the quality of life for individuals with Intellectual and Developmental Disabilities
StationMD is an equal opportunity employer.
#J-18808-Ljbffr