Payer Enrollment Specialist: Credentialing & Reimbursement

Socket.dev; Tucson (AZ); On-site; USD 2,929,000 - 4,393,000; Full time

Job summary

El Rio Health in Tucson, AZ is seeking a Payer Enrollment Specialist to coordinate enrollment and re-enrollment for providers and facilities. You will monitor status with payors, resolve issues, and maintain compliance with government and commercial payors.

The role requires at least two years in payer enrollment or related healthcare insurance experience, and a Level I fingerprint clearance. Bilingual Spanish/English is preferred.

Qualifications

• Two years in Payer Enrollment or equivalent healthcare insurance experience.
• Fingerprint Clearance Card – Level I, current and in good standing or applied within seven working days.

Responsibilities

• Completes and submits enrollment applications to Medicare, Medicaid, and commercial payors.
• Monitors status, follows up with payors, and resolves deficiencies for timely approvals.
• Maintains enrollment records, credentialing files, rosters and documentation per requirements.
• Processes updates to demographics, locations, ownership, licensure, NPI, CAQH, and related data.
• Tracks deadlines to prevent enrollment lapses and interruptions in reimbursement.
• Coordinates with credentialing, medical staff, HR, compliance and revenue cycle teams.
• Acts as primary contact for payors, providers, and internal staff.
• Investigates enrollment discrepancies and disconnects.
• Keeps up with federal/state enrollment requirements and regulatory changes.
• Generates enrollment reports and performance metrics.

Skills

Payer enrollment

Bilingual English/Spanish

Education

High School Diploma or GED

Job description

El Rio Health in Tucson, AZ is seeking a Payer Enrollment Specialist to coordinate enrollment and re-enrollment for providers and facilities. You will monitor status with payors, resolve issues, and maintain compliance with government and commercial payors.

The role requires at least two years in payer enrollment or related healthcare insurance experience, and a Level I fingerprint clearance. Bilingual Spanish/English is preferred.