Payer Enrollment Specialist

CredSpun LLC; United States; Remote; USD 50,000 - 80,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Payer enrollment experience

Credentialing or billing setup

PECOS experience

NPI/type 1/2 understanding

Attention to detail

Written communication

Tools

PECOS

CAQH ProView

Availity

Office Ally

Change Healthcare

Job description

Enroll practices and providers with Medicare, Medicaid, managed care and commercial payers — then set up the EDI, ERA and EFT connections that let them get paid.

New practices, new locations and new providers all need the same thing before they can bill: enrollment with each payer, linked to the right group, tax ID and location, with claims and payments flowing electronically. As a payer enrollment specialist you handle the group side of that work and the plumbing that follows it.

You will work closely with our credentialing specialists. They focus on the individual provider file; you focus on group enrollment, linkage, and the EDI, ERA and EFT setup that is easy to forget and expensive to miss.

What you will do

• 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

What you need

• 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

Helpful, not required

Experience with CAQH ProView, Availity and payer-specific portals, and with clearinghouse enrollment in tools such as Office Ally, Availity or Change Healthcare.