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Payer Enrollment Specialist
V2V Management Solutions. Complete initial, reassignment, and revalidation applications with Medicare for entities and providers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in credentialing and payer enrollment processes, with proficiency in managing PECOS, Medicaid, and CAQH systems. Strong communication and project management skills support effective client interactions and timely completion of enrollment applications.
Highest-signal resume keywords
Credentialing ExpertisePayer Enrollment ManagementPECOS System KnowledgeAdvanced Communication SkillsRevenue Cycle Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CredentialingPayer EnrollmentRevenue Cycle WorkflowMedicaid KnowledgeHealth Insurance ConceptsProject ManagementMicrosoft Office ProficiencyCAQH ManagementDecision-MakingProblem-Solving
Soft Skills
Customer ServiceConflict ResolutionCritical ThinkingAdaptabilityIntegrity
Tools & Technologies
PECOS PortalNPPES PortalAvaility PortalEcho One AppVerity Products
Industry Keywords
MedicareHMOPPOManaged CareDSNIPHealthcare SettingProvider EnrollmentInsurance AgencyOperational ProcessesEligibility Functions
About the role
Key responsibilities & impact- Complete initial, reassignment, and revalidation applications with Medicare for entities and providers
- Complete initial, reassignment, and revalidation applications with various state Medicaid programs for entities and providers
- Complete initial, reassignment, and revalidation applications with various commercial insurance payers for entities and providers
- Maintain PECOS portal for providers, including approval of facilities and updating demographic information
- Manage and maintain NPPES portal for providers
- Create, update, and maintain CAQH profiles for providers
- Complete privileging for facility enrollment paperwork for providers and return it to the facility in a timely manner
- Support clients by providing advisory services for organizational-level NPI management and provider enrollment challenges
- Manage Availity portal for various insurance networks
- Communicate regularly with clients and associated providers to ensure timely completion of the enrollment application process
Requirements
What you’ll need- Subject matter expertise in credentialing & payer enrollment
- Extensive knowledge in health insurance third party administrator concepts, specifically supporting operational processes for enrollment and eligibility functions
- Revenue cycle workflow and operations experience is a plus
- Working knowledge of PECOS, Medicaid, and CAQH systems
- Knowledge of health insurance, HMO, PPO, DSNIP and managed care principles including Medicare Advantage regulations
- Effective decision-making, problem-solving, conflict resolution, and critical thinking skills
- Ability to learn new software programs quickly
- Proficiency in Microsoft Office suite
- Experience with Echo One App, Verity products, or other credentialing software solutions is a plus
- Exceptional customer service and professional interaction skills with co-workers, clients, providers, and vendors
- Advanced verbal and written communication skills
- Advanced project management, planning and prioritization skills
- Ability to drive and support innovation and best practices
- Readily adapts to changing work demands, is flexible, works independently, and takes initiative making independent decisions
- Ability to serve others with integrity and maintain confidentiality
- 5-7 years’ experience working within the insurance agency, hospital or other healthcare setting with responsibilities related to credentialing or provider enrollment
- Additional 1-3 years’ experience working within the healthcare industry relating specifically to the revenue cycle process
- Associate or bachelor’s degree preferred
Benefits
Comp & perks- Health Insurance - 100% Employer Paid
- Additional Voluntary Benefits
- Cell Phone Stipend
- 401(k) matching
- Training & development
- 401(k)
- Competitive salary
- Dental insurance
- Paid time off
- Flexible work from home options available