Payer Enrollment Specialist

Tishman Speyer Properties; Vadodara; On-site; INR 650,000 - 1,000,000; Full time

Job summary

Qualifacts is seeking an EDI Enrollment Manager to prepare, submit, monitor, and maintain electronic enrollment requests across payer portals and clearinghouses. You will validate provider data, coordinate with payers, and track milestones from enrollment to activation, ensuring accuracy and compliance with HIPAA.

You will collaborate with Credentialing, Billing, AR, Client Success, and Implementations teams to support onboarding and revenue cycle readiness. Equal opportunity employer.

Job description

Job Description: EDI Enrollment Management: Prepare, submit, monitor, and maintain EDI enrollment requests for electronic transactions, including: Electronic Claims (837) Electronic Remittance Advice (ERA/835) Electronic Funds Transfer (EFT) Claim Status transactions (276/277), where applicable Eligibility transactions (270/271), where applicable Complete payer-specific electronic enrollment applications through payer portals, clearinghouses, and paper enrollment processes, as required. Coordinate EDI enrollments with clearinghouses and insurance payers to establish electronic connectivity for assigned providers and client groups. Validate provider demographic information, National Provider Identifier (NPI), Tax Identification Number (TIN), billing information, and banking details before submission to ensure enrollment accuracy. Track enrollment status, payer responses, effective dates, approvals, and activation milestones through completion. Payer & Clearinghouse Follow-up: Perform timely follow-up with insurance payers and clearinghouses to obtain enrollment status, resolve deficiencies, and expedite approvals. Investigate and resolve rejected, delayed, or incomplete EDI enrollment requests. Escalate aging enrollments, payer delays, or connectivity issues that may impact claims submission or payment processing. Maintain consistent communication with internal stakeholders regarding enrollment progress, risks, and expected completion timelines. Documentation & Quality: Maintain accurate documentation within enrollment systems, work queues, trackers, CMD records, and document repositories. Document payer communications, enrollment approvals, rejection reasons, and corrective actions in accordance with RCMS documentation standards. Ensure all enrollment records are complete, current, and audit-ready. Safeguard sensitive provider and banking information while adhering to HIPAA and organizational security requirements. Cross-Functional Collaboration: Partner with Credentialing, Billing, AR, Payment Posting, Client Success, Implementations, and U.S.-based teams to support provider onboarding and revenue cycle readiness. Coordinate with internal departments to resolve enrollment dependencies affecting electronic claims submission or payment processing. Support new client implementations, provider onboarding, and organizational growth initiatives by ensuring timely EDI setup. Identify process improvement opportunities to reduce enrollment turnaround times, improve first-pass approval rates, and standardize EDI workflows. Assist in training team members and sharing payer-specific EDI enrollment knowledge and best practices. For more than 20 years, Qualifacts has delivered thoughtful innovation, technology, support, and services to the behavioral health and human services market. Most recently, Qualifacts has been on a mission to expand its portfolio to support the patient continuum, from the initial appointment request to final billing and reporting, and everything in between. Qualifacts has headquarters in Nashville and Tampa with employees across the globe, many with strong healthcare and clinical backgrounds to help bring you the best solutions possible.

Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.