Payor Contractor Enrollment Specialist en PathGroup

Job Summary:

• The Payor Contracting, Enrollment Specialist will serve as the in-house expert in government enrollments and commercial payor credentialing as well as in resolving payor contracting departmental issues related to enrollments and credentialing.  They are responsible for performing and maintaining all government enrollments for physicians and laboratory entities and will oversee the Payor Contracting Enrollment Coordinators and the commercial payor credentialing process. 

Essential Responsibilities/Duties:

• Establishes and preserves quality working relationships with internal and external customers, utilizing excellent customer service skills to solidify relationships.
• Maintains an up-to-date tracker for each entity.
• Provides portal access to RCM team & vendors as requested
• Serve as the expert on terms of the enrollments and payer contract credentialing requirements for reporting to impacted internal and external parties.
• Work with management to facilitate problem solving of escalated enrollment/credentialing and/or reimbursement issues through collaboration with managed care organizations and internal stakeholders.
• Update the company’s records, licensures, and certifications, on payor portals as requested.
• Monitors and maintains credential documents are accurate.
• Examine, research, enter data, file, and gather all information necessary to process information received from payors to support the credentialing process.
• Respond to telephone and written inquiries related to the credentialing process.
• Meet or exceed all deadline requirements for provider communications, enrollments and follow- ups.
• Lead, promote, and support payer contracting across the organization.
• Partner with leadership to formulate and integrate payer contracting strategies