Enrollments Specialist

APS Health; Nashville, Northern (TN, KY); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Employee Stock Option Plan (ESOP)

Paid CME

Generous PTO

Life insurance

Disability insurance

Job summary

AP Health specializes in perioperative services and is seeking a dedicated professional to oversee payer enrollment operations. The role supports the provider enrollment process, collaborates with the RCM team, and ensures enrollment accuracy from hire through ongoing employment.

The ideal candidate has 2+ years in healthcare revenue cycle with payer enrollment experience, is familiar with Availity/Optum portals, and upholds HIPAA standards while communicating effectively within teams.

Qualifications

• 2+ years in healthcare revenue cycle with 2+ years managing payer enrollments (Medicare, Medicaid, Commercial).
• Knowledge of payer enrollment processes and reimbursement rules.
• Familiarity with payer portals like Availity and Optum.
• Comply with HIPAA regulations and other healthcare standards.
• Excellent communication and collaboration skills with a problem-solving approach.

Responsibilities

• Oversee and execute end-to-end provider enrollment processes with in-network payers while maintaining an active roster.
• Collaborate with Revenue Cycle Management to troubleshoot and resolve denials.
• Connect with providers and payers to complete enrollment during hire and maintain throughout employment.
• Navigate payer portals (Availity, Optum) to submit enrollment applications and track statuses.
• Work with People Operations during onboarding to gather information for timely enrollments.
• Manage providers CAQH profiles through employment lifecycle.
• Assist in establishing Revenue Cycle SOPs and data workflows and provide feedback on enhancements.

Skills

Payer enrollment management

Revenue cycle knowledge

HIPAA compliance

Effective communication

Education

Associate’s or Bachelor's in healthcare administration or related field

Tools

Availity portal

Optum portal

Job description

AP Health offers skilled advanced practice providers an opportunity for career control, flexibility, competitive compensation and ownership interest in the company.

AP Health is a private practice comprised of advanced practice providers. We provide perioperative services to hospitals, surgeons, and surgery centers. This role will specialize in payer enrollment operations for our facility-based model.

What you will do:

• Oversee and execute end-to-end provider enrollment processes with in-network payers while maintaining an active roster
• Work with the broader Revenue Cycle Management team to troubleshoot and work through denials as needed
• Connect with providers and payers to efficiently complete the enrollment process upon provider hire and maintain throughout their employment
• Navigate payer portals like Availity, Optum, and others to submit enrollment applications, track statuses, and resolve enrollment delays
• Collaborate with our People Operations team during the provider onboarding process to gather information and begin timely enrollments
• Manage providers CAQH profiles through employee lifecycle
• Assist in establishing Revenue Cycle SOPs and data workflows, providing feedback on enhancements for internal software and external leveraged resources

What do you need:

• 2+ years of experience in healthcare revenue cycle with 2+ years managing payer enrollments (Medicare, Medicaid, and Commerical)
• Knowledge of payer enrollment processes and reimbursement rules
• Familiarity with portals like Availity and Optum
• Comply with HIPAA regulations and other healthcare standards
• Excellent communication and collaboration skills with a problem-solving approach
• Preferred Associate’s or Bachelor’s in healthcare administration, business, or related field (*equivalent experience also accepted)
• Preferred certifications in PECOS/CAQH training
• Comprehensive and flexible medical, dental, and vision insurance
• Short and long-term disability, basic and supplemental life
• 401K retirement plan with company matching
• Participation in the company’s Employee Stock Option Plan (ESOP)
• Paid state license, malpractice, and other agreed upon licenses and dues
• Annual $1,500 allotment accompanied by 3 paid days off for Continuing Medical Education (CME)
• Generous PTO and "life/work" balance
• Excellence at Work: AP Health is a certified Great Place to Work- a national designation based on employee feedback about trust, workplace culture, and experience.