Remote Senior Payer Enrollment Specialist

Job Description

The Senior Payer Enrollment Specialist is responsible for completing accurate and timely health plan enrollment requests on behalf of clients. This role will be responsible for researching and resolving payer or client related questions on their own with little oversight from their lead or manager.

This individual will use a combination of internal proprietary tools and standard communication methods (email, phone, fax, etc..) to complete enrollments. From time to time, a Specialist may interact with clients and internal teams to improve processes and support new tool development.

This role reports to one of the Payer Enrollment Team Leader.

Responsibilities:

Complete health plan enrollment requests from application retrieval thru notifying clients upon request completion. This includes group and individual applications with Medicare, Medicaid, commercial and managed care health plans

Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations

Research payer issues, including new payers and managed care payers, with little oversight from lead/manager, and work to resolve issues quickly and effectively so issues do not return

Strong understanding of the Medicaid enrollment process for both individual providers and groups, including but not limited to revalidations, medical license expirations, deactivations, NPI taxonomy importance, complex entity ownership models

Follow up on enrollments in process (telephone, email, and portal) and maintain enrollment records thru timely documentation

Submit selected applications to be audited, working toward 100% accuracy and not needing any applications to be audited, for both individual provider applications and group applications

Ensure all supporting documentation in provider profiles. This includes all onboarding documents, application copies, welcome letter, and other correspondence

Create client updates and participate in client calls as needed

Establish close working relationships with payer representatives and contracting departments in order to streamline future submissions and improve approval times

Perform other duties as assigned

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:

Skills and Requirements

4+ years of payer enrollment experience, including group and individual applications with Medicare, Medicaid, commercial and managed care health plans

Detail oriented and able to ensure the complex enrollment packages are complete and correct

Able to communicate well with a wide variety of internal and external contacts at all levels of the organization

Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization Expertise in using GSuites tools include GSheets, GDocs, and GMail, Adobe Acrobat Pro

Experience in fast paced remote, startup like environment