Payer Enrollment Specialist

Obtain, verify, analyze, and maintain all documentation required for provider, group, facility, and ancillary payer enrollments, ensuring accuracy and completeness prior to submission.

Coordinate and manage the payer enrollment lifecycle from initiation through approval, including application preparation, submission, follow-up, resolution of deficiencies, and final payer activation.

Prepare, submit, track, and maintain provider and organizational enrollments, revalidations, recredentialing applications, demographic updates, ownership changes, and provider roster submissions for commercial, Medicare, Medicaid, and other government payers.

Initiate payer contracting requests and collaborate with contracting to facilitate network participation.

Track all enrollment activities within CredentialStream ensuring documentation, status updates, milestones, and approvals are accurately recorded and maintained.

Maintain and continuously update payer-specific enrollment checklists, requirements, submission guidelines, and supporting documentation standards to ensure accurate first-pass submissions and reduce enrollment delays and denials.

Follow payer-specific enrollment checklists and established workflows to ensure applications are submitted accurately, completely, and within required turnaround times.

Conduct ongoing payer follow-up activities to resolve enrollment issues, obtain status updates, address deficiencies, and expedite approvals when necessary.

Interface directly with health plans, Medicare Administrative Contractors (MACs), Medicaid agencies, provider representatives, and payer relations contacts to support enrollment and credentialing activities.

Ensure ongoing accuracy, completeness, and maintenance of provider CAQH profiles, attestations, supporting documents, and related databases.

Coordinate CLIA certificate applications, renewals, updates, and maintenance activities for applicable locations.

Responsible for learning the aspects of compliance in the company by completing all mandatory compliance training

The ability to maintain friendly, cordial relations with all employees.

The ability to build and maintain confidence and credibility with all employees.

The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers.

The ability to perform the physical, use of senses, cognitive, and environmental functions of the position, as specified on the physical demands.

Ability to comply with Company standards of operations.

Ability to adhere to the Core Values of the Company, of teamwork, communication, empowerment, quality of care, and friendliness.

Supervisory Responsibilities : no direct reports

Hours Required: Full Time hourly Position, overtime as approved by management

Experience:

Minimum of 4 years of progressive payer enrollment experience within a multi-location medical group or multi-specialty healthcare organization.

Multi-state payer enrollment experience

Demonstrated experience with:

PECOS

Medicaid and multi-state Medicaid enrollment

Commercial payer enrollment

Group and facility enrollments

Payer revalidations

EDI, ERA, and EFT enrollment processes

Experience using payer enrollment and credentialing systems such as CredentialStream or similar.

Experience utilizing payer portals including Availity, CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer portals.

Waystar and Athena portal experience preferred.

Experience initiating payer contracting and network participation requests preferred.

Knowledge of payer enrollment regulations, enrollment lifecycle management and payer participation requirements.

Fast Pace Health is committed to the principle of equal employment and creating an inclusive environment for the benefit of our employees, our patients, and our communities. We are an equal opportunity employer and welcome job applications from qualified individuals without regard to race, creed, color, ancestry, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, disability, veteran status, marital status, parental status, genetic information or any other legally protected characteristics or conduct. Please refer to the links below for information regarding your rights under certain federal laws: https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/fmlaen.pdf https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf Mississippi Residents Only: In Mississippi, Fast Pace requires pre-employment/drug/alcohol testing as a condition of employment. The law requires that Fast Pace notify applicants, in writing, upon application and prior to the collection of the specimen for drug and alcohol test, that they may be tested for “the presence of drugs [or alcohol] in their metabolites.” Miss. Code. Ann. § 71-7-3(5).

Applicants are limited to individuals from states, excluding the following: California, Colorado, Hawaii, Illinois, New Jersey, New York, Rhode Island, Washington, and the District of Columbia.