Payer Enrollment & EDI Setup Specialist

CredSpun LLC; United States; À distance; USD 50 000 - 80 000; Plein temps

Résumé du poste

CredSpun LLC is seeking a payer enrollment specialist to handle group enrollment, linkage, and the EDI, ERA and EFT setup that enable claims and payments to flow smoothly for new practices, locations and providers.

You will enroll groups in PECOS, complete Medicaid enrollment, add providers and locations to contracts, and maintain enrollment grids, working closely with credentialing specialists to ensure accurate payer linkage and timely revalidations.

Qualifications

• One or more years of payer enrollment, credentialing or billing setup experience.
• Experience with PECOS and at least one state Medicaid enrollment portal.
• Understanding of type 1 and type 2 NPIs, tax IDs, taxonomy codes and group linkage.
• Careful attention to detail on forms where one wrong digit stalls an application.
• Good written communication for payer correspondence and client updates.

Responsabilités

• Submit and track Medicare group and individual enrollment and reassignment in PECOS.
• Complete state Medicaid and Medicaid managed care plan enrollment.
• Add providers and locations to existing commercial contracts and confirm linkage.
• Set up EDI claim submission, ERA (835) and EFT enrollment with each payer and the clearinghouse.
• Update NPPES records, practice locations and pay-to addresses when anything changes.
• Handle revalidation notices and ownership or tax ID changes on time.
• Keep an enrollment grid for each client showing every payer, status and effective date.

Connaissances

Payer enrollment experience

Credentialing or billing setup

PECOS experience

NPI/type 1/2 understanding

Attention to detail

Written communication

Outils

PECOS

CAQH ProView

Availity

Office Ally

Change Healthcare

Description du poste

CredSpun LLC is seeking a payer enrollment specialist to handle group enrollment, linkage, and the EDI, ERA and EFT setup that enable claims and payments to flow smoothly for new practices, locations and providers.

You will enroll groups in PECOS, complete Medicaid enrollment, add providers and locations to contracts, and maintain enrollment grids, working closely with credentialing specialists to ensure accurate payer linkage and timely revalidations.