Payer Enrollment Specialist for Healthcare Credentialing

Guidehouse; Oregon; Hybrid; USD 35,000 - 58,000; Full time

Job summary

Guidehouse in Oregon is hiring a Payer Enrollment Specialist responsible for timely enrollment of healthcare providers with major insurance vendors. You will manage payer enrollment, coordinate with credentialing, resolve issues, and maintain delegated rosters to meet payer requirements.

You will complete initial and re-enrollment applications, track statuses in MD-Staff or similar systems, and generate reports for leadership. Medical group operations and compliance are core to the role.

Qualifications

• High School Diploma or GED or 3 years of relevant equivalent experience.
• 1-3+ years in office, business, operations, customer service or healthcare.
• Experience with payer enrollment software (MD-Staff) is a plus.

Responsibilities

• Complete and manage payer applications for initial enrollment and re-enrollment, ensuring compliance with organizational standards and regulatory requirements.
• Coordinate with insurance payers to maintain accurate provider enrollment records for both government and commercial payers.
• Develop and distribute monthly delegated provider rosters, ensuring all provider status information remains current and accurate.
• Work closely with the medical credentialing team to ensure seamless updates for provider enrollments and terminations.
• Serve as a point of contact for payer enrollment inquiries and issues, providing timely support to both internal teams and external partners.
• Proactively identify and resolve enrollment-related issues with insurance payers to minimize delays and maintain provider compliance.
• Accurately enter, maintain, and update provider information in payer enrollment systems, following data standards.
• Utilize MD-Staff or similar software to track application statuses and ensure timely follow-up on pending enrollment requests.
• Regularly update tracking spreadsheets to monitor outstanding items, follow up as necessary, and provide enrollment reports to leadership and stakeholders.
• Generate reports on enrollment progress, compliance, and delegated roster updates, sharing findings with internal stakeholders and recommending improvements as needed.

Skills

Customer service

Office operations

Healthcare experience

Education

High School Diploma or GED

Tools

MD-Staff

Job description

Guidehouse in Oregon is hiring a Payer Enrollment Specialist responsible for timely enrollment of healthcare providers with major insurance vendors. You will manage payer enrollment, coordinate with credentialing, resolve issues, and maintain delegated rosters to meet payer requirements.

You will complete initial and re-enrollment applications, track statuses in MD-Staff or similar systems, and generate reports for leadership. Medical group operations and compliance are core to the role.