Payer Enrollment Specialist

• Serve as the enrollment implementation lead for in-network participation with commercial and government payers. 

• Manage post execution payer enrollment and participation activities, including provider and group enrollment, roster submissions, and provider to group affiliation requirements. 

• Ensure payer participation status supports accurate billing and reimbursement under applicable networks and products. 

• Manage operational execution for out of network payer participation, including setup and maintenance of Letters of Agreement and other payer specific arrangements. 

• Serve as the primary point of contact for resolving out of network participation issues that impact claims processing or reimbursement. 

• Manage provider to payer affiliation activities, including roster management, provider demographic updates, and payer attestation requirements. 

• Maintain participation continuity for individual providers and groups to support uninterrupted billing and reimbursement. 

• Manage government payer enrollment and participation activities, including Medicare, Medicaid, and other applicable programs 

• Oversee enrollment maintenance and revalidation requirements to ensure continuous participation and compliance with program deadlines 

• Manage payer enrollment and participation requirements specific to Intraoperative Neuromonitoring (IONM) services. 

• Collaborate with billing and revenue cycle teams to ensure payer participation supports compliant billing and reimbursement within hospital-based care environments 

• Monitor payer directories and network listings to ensure accurate provider participation status and network representation. 

• Identify and address directory inaccuracies or network issues, including silent PPO or rental network arrangements, that impact reimbursement. 

• Maintain accurate provider and organizational enrollment data across payer and regulatory systems to support participation and reimbursement. 

• Manage payer required documentation and electronic payment enrollment activities in coordination with internal teams. 

• Investigate and resolve reimbursement issues attributable to payer enrollment or participation status, coordinating with payer representatives as needed. 
• Serve as the escalation point for enrollment related issues impacting claims processing, providing participation guidance to billing and revenue cycle teams.