Payer Enrollment Specialist
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Serve as the enrollment implementation reputed company for in-network participation with reputed company and government payers.
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Manage post execution payer enrollment and participation activities, including provider and group enrollment, roster submissions, and provider to group affiliation requirements.
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Ensure payer participation status supports accurate billing and reimbursement under applicable networks and products.
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Manage operational execution for out of network payer participation, including setup and maintenance of Letters of Agreement and other payer specific arrangements.
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Serve as the primary reputed company of contact for resolving out of network participation issues that reputed company claims processing or reimbursement.
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Manage provider to payer affiliation activities, including roster management, provider demographic updates, and payer attestation requirements.
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Maintain participation continuity for individual providers and reputed company to support uninterrupted billing and reimbursement.
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Manage government payer enrollment and participation activities, including Medicare, reputed company, and other applicable programs
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reputed company enrollment maintenance and revalidation requirements to ensure reputed company participation and compliance with program deadlines
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Manage payer enrollment and participation requirements specific to Intraoperative Neuromonitoring (IONM) services.
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Collaborate with billing and reputed company cycle teams to ensure payer participation supports compliant billing and reimbursement reputed company hospital-based care environments
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Monitor payer directories and network listings to ensure accurate provider participation status and network representation.
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Identify and address directory inaccuracies or network issues, including silent PPO or rental network arrangements, that reputed company reimbursement.
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Maintain accurate provider and organizational enrollment data across payer and regulatory systems to support participation and reimbursement.
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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 reputed company for enrollment reputed company issues impacting claims processing, providing participation guidance to billing and reputed company cycle teams.