Payer Enrollment Specialist

Penn Medicine, University of Pennsylvania Health System; Philadelphia (Philadelphia County); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Penn Medicine is seeking a Payer Enrollment Specialist to support the Indemnity Enrollment Team with Medicare and Medicaid at our hybrid location in Philadelphia. The role ensures enrollment with contracted health plans to enable billing and reimbursements for services.

The individual will handle enrollment processes, resolve enrollment issues, and coordinate with internal departments and health plans to deliver timely provider enrollments.

Qualifications

• HS Diploma or GED is required.
• 2+ years of payer enrollment experience in healthcare preferred.

Responsibilities

• Complete provider enrollment in a timely and efficient manner according to service standards.
• Coordinate with health plan staff to meet information needs and obtain provider numbers.
• Submit and follow up on enrollment applications to assigned health plans for network inclusion.
• Ensure provider and practice changes are submitted to health plans and processed correctly.
• Perform special projects and run reports to support enrollment activities.
• Maintain proficiency with enrollment databases and systems (e.g., PECOS, Navinet, CAQH).
• Act as liaison between departments/practices and health plans to resolve issues.
• Analyze enrollment reports to confirm provider enrollments are completed.
• Investigate data errors or inconsistencies in enrollment databases and escalate as needed.
• Adhere to Penn Medicine values, policies, and procedures.

Skills

Payer enrollment experience

Healthcare enrollment coordination

Effective communication

Education

HS Diploma/GED

Job description

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Entity: Corporate Services

Department: Medical Affairs

Location: 3535 Market street, hybrid

Penn Medicine is seeking a Payer Enrollment Specialist to support the Indemnity Enrollment Team with Medicare and Medicaid.

Summary

Individual will be part of a team responsible for the enrollment of Penn Medicine billable (employed/contracted) practitioners with contracted health plans to ensure Penn Medicine's ability to bill and receive reimbursement for services rendered to patients. Includes understanding and complying with the enrollment processes of assigned health plans, researching and resolving enrollment related issues, and communicating with internal and external clients. The individual will be responsible for initiating the enrollment process and tracking it to completion with assigned health plan(s).

Responsibilities

• Works with providers, departments, and Professional Billing Office staff to complete provider enrollment process in a timely and efficient manner in accordance with service standards
• Works with health plan staff to ensure their information needs are met and that they provide provider numbers on a timely basis
• Completes, submits and follows up on managed care exports and/or indemnity or Behavioral Health applications sent to the assigned health plans for enrollment into their network.
• Ensures that provider and practice changes are submitted to the assigned health plans and are accurately processed by the health plans.
• Performs special projects and/or run reports to support the provider enrollment process for the assigned health plans
• Maintains proficiency in utilization of enrollment databases and other systems required for enrollment with assigned health plans (e.g. PECOS, Promise, Navinet, CAQH, Health Plan Portals).
• Serves as liaison between the departments/practices and health plans in order to resolve enrollment issues.
• Analyzes the various Enrollment Reports for assigned plans to ensure that the providers’ enrollments have been completed with the health plans.
• Researches department/practice complaints and/or independently identifies data errors/inconsistencies and other problem areas with enrollment database and resolves or refers issues to manager as appropriate.
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
• Other duties as assigned to support the unit, department, entity, and health system organization

Education or Equivalent Experience

• H.S. Diploma/GED is required.
• 2+ years of experience working in payer enrollment and/or in a similar position (preferably in a health care organization), is required.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.