Analysis Skills, Billing, Business Administration, Communication Skills, Content Management Systems (CMS), Detail Oriented, Government, Health Plan, Healthcare, Healthcare Administration, Healthcare Providers, Hospital, Insurance, Internet Application, Leadership, Medicaid, Medical Billing, Medicare, Microsoft Office, Multitasking, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Provider Credentialing, Regulations, Regulatory Compliance, Regulatory Requirements, Reimbursement, Team Player, Time Management, Writing Skills
Summary
Job Summary
The Payer Enrollment Specialist is responsible for coordinating and managing the enrollment, revalidation, and maintenance of healthcare providers with government and commercial insurance payers. Ensures providers and service locations are properly enrolled with payers to allow compliant billing and reimbursement for services rendered. Works closely with credentialing, medical staff services, revenue cycle leadership, and payer representatives to ensure timely enrollment and regulatory compliance.
Minimum Job Requirements:
Work Experience:
Two years of experience in healthcare provider enrollment, credentialing, or medical billing, including Medicare, Medicaid, and commercial payer processes. Hospital or multi- specialty experience preferred.
Familiarity with Medicare, Medicaid, and commercial payer enrollment processes.
License/Registration/Certification:
None
Education and Training:
High school diploma or equivalent required.
Associate’s degree in Healthcare Administration, Business Administration, or related field preferred.
Skills:
- Knowledge of Medicare, Medicaid, and commercial payer enrollment requirements and processes.
- Knowledge of CMS regulations, payer guidelines, and enrollment compliance standards.
- Preferred knowledge of CAQH, PECOS, TMHP, and payer enrollment portals.
- Proficiency in using credentialing or enrollment software, payer portals, and Microsoft Office Suite.
- Strong analytical and problem‑solving abilities to identify and resolve enrollment issues.
- High level of attention to detail with a strong commitment to regulatory and payer compliance.
- Ability to review, understand, and consolidate complex regulatory and payer information.
- Skill in preparing, reviewing, and submitting accurate enrollment applications and documentation.
- Ability to manage multiple priorities and deadlines in a fast‑paced hospital or healthcare environment.
- Skill in tracking and maintaining organized, audit‑ready enrollment records and logs.
- Effective verbal and written communication skills for individual and group settings.
- Ability to follow and deliver detailed verbal and written instructions accurately.
- Skill in communicating professionally with insurance payers, providers, and internal departments.
- Ability to collaborate cross‑functionally with Credentialing, Medical Staff Services, and Billing teams.
- Ability to adapt to changing payer requirements and regulatory updates.
U
University Medical Center of El Paso