Work Schedule: Pacific Timezone
Work Set-Up: Onsite onboarding for four weeks, then transitioning to a remote setup
About the Job
The Payer Enrollment Specialist is responsible for completing accurate and timely insurance enrollment requests on behalf of our clients. The Specialist is also responsible for researching and resolving payer or client-related questions related to their submitted enrollments. The Specialist will use a combination of internal proprietary client tools, 3rd party partner tools, and standard communication methods (email, phone, fax, etc.) to complete enrollments. The Specialist will keep accurate and up-to-date records via customer support platforms and maintain clear and timely communications with customers regarding the records.
Duties and Responsibilities:
- Complete health plan enrollment requests from application retrieval through notifying clients upon request completion. This includes group and individual applications with Medicare, Medicaid, commercial, and managed care health plans.
- Follow up on enrollments in process (telephone, email, and portal) and maintain enrollment records for the client through timely documentation.
- Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.
- Ensure the client has all supporting documentation in provider profiles. This includes all onboarding documents, application copies, welcome letters, and other correspondence.
- Create client updates and participate in client calls as needed.
- Establish close working relationships with payer representatives and contracting departments to streamline future submissions and improve approval times.
- Assist with revalidation processes to ensure provider participation in health plans remains active.
- Monitor and track payer enrollment timelines, deadlines, and ensure compliance with submission requirements.
- Investigate and resolve enrollment delays, rejections, or discrepancies by communicating with providers and payers.
- Maintain up-to-date knowledge of payer policies, state/federal regulations, and industry best practices for enrollment processes.
- Maintain accurate records and provide timely updates on all enrollment requests.
- Perform other duties as assigned.
Job Requirements:
- Bachelor's Degree of any related field
- 5+ years’ experience as a Payer Enrollment Specialist.
- Strong proficiency in the English language and excellent customer service skills.
- Familiarity with payer enrollment-related applications and processes.
- Expertise in MS Office applications. Able to quickly learn new software applications.
- 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.
- Familiarity with Inovalon clearinghouse preferred.
WHY INTELASSIST?
We grow together. We value your effort. We aim to empower you.
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Last updated on Jan 27, 2025