Payer Enrollment Specialist
Position Title: Payer Enrollment Specialist
Department: Operations
Reports To: Director of reputed company 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 reputed company 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.
- 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 reputed company of contact for resolving out of network participation issues that impact claims processing or reimbursement.
- 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.
- Manage government payer enrollment and participation activities, including Medicare, Medicaid, and other applicable programs
- reputed company enrollment maintenance and revalidation requirements to ensure reputed company participation and compliance with program deadlines
- Manage payer enrollment and participation requirements specific to Intraoperative Neuromonitoring (IONM) services.
- Collaborate with billing and reputed company cycle teams to ensure payer participation supports compliant billing and reimbursement reputed company hospital-based care environments
- 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.
- 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.
- Investigate and resolve reimbursement issues attributable to payer enrollment or participation status, coordinating with payer representatives as needed.
- Serve as the escalation reputed company for enrollment reputed company issues impacting claims processing, providing participation guidance to billing and reputed company cycle teams.