Payer Enrollment Specialist - Manning - Human Resources

ViziRecruiter,LLC.; Tucson (AZ); On-site; USD 29,000 - 44,000; Full time

Job summary

ViziRecruiter, LLC in Tucson, AZ is seeking a Payer Enrollment Specialist to manage provider and facility enrollment across Medicare, Medicaid, and commercial payors.

This role coordinates timely enrollment, monitors statuses, maintains credentialing files, and collaborates with revenue cycle teams to ensure optimal reimbursement. Ideal candidates have a HS diploma and 2 years in payer enrollment, with fingerprint clearance and bilingual skills preferred.

Qualifications

• High School Diploma or G.E.D.
• Two years in Payer Enrollment role or equivalent healthcare insurance experience.
• Level I fingerprint clearance card: current valid and in good standing or applied within seven working days.

Responsibilities

• Completes and submits provider facility enrollment, revalidation, reenrollment, and recredentialing to Medicare, Medicaid, and payors.
• Monitors enrollment status, follows up with payors, and resolves deficiencies to ensure timely approvals.
• Maintains enrollment records, credentialing files, rosters, and documentation in compliance with regulations.
• Processes provider and facility updates (demographics, practices, licensure, NPI, CAQH).
• Tracks revalidation, reenrollment, and expiration deadlines to prevent lapses.
• Coordinates with credentialing, HR, compliance, and billing teams for enrollment success.
• Serves as primary contact for payors, providers, and staff on enrollment inquiries.
• Investigates enrollment discrepancies and disconnects affecting providers.
• Keeps knowledge up-to-date on enrollment requirements and process improvements.
• Generates enrollment reports and performance metrics.

Skills

Two years payer enrollment experience

Bilingual English/Spanish (preferred)

Education

High School Diploma or G.E.D.

Job description

Introduction

Are you are looking for a career with one of Tucson’s largest, most highly regarded healthcare organizations that offers generous benefits, competitive salaries, free health classes and makes a difference in the lives of more than one in ten Tucsonans?

Overview

Salary: $21.26 - $31.89 per hour, depending on qualifications

Schedule: Monday - Friday, 8am - 5pm

The Payer Enrollment Specialist is responsible for coordinating, monitoring, and maintaining the provider and facility enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Assists with problem identification and timely resolution of payer related issues surrounding claim submission and denial management to ensure optimal reimbursement.

Responsibilities

• Completes and submits provider facility enrollment, revalidation reenrollment, and recredentialing applications to Medicare, Medicaid, commercial insurance carriers, and other third-party payors in accordance with payor-specific requirements.
• Monitors enrollment applicationsstatus, conduct follow-up with payors, and resolve application deficiencies to ensure timely approvals and prevent delays in provider participation and reimbursement.
• Maintains accurate providerand facility enrollment records, credentialing files, rosters, databases, and supporting documentation in compliance with organizational, regulatory, payor, and FQHC requirements.
• Processes and submits provider and facility updates, including changes to demographics, practice locations, ownership, specialties, licensure, taxonomy, NPI, CAQH, and other enrollment-related information.
• Tracks revalidation, reenrollment, recredentialing, and document expiration deadlines to prevent enrollment lapses, claim denials, and interruptions in reimbursement.
• Coordinates with credentialing, medical staff, human resources, compliance, and provider onboarding, revenue cycle, and billing teams to facilitate timely provider enrollment and successful provider onboarding.
• Serves as the primary point of contact for payors, providers, and internal staff regarding enrollment inquiries, status updates, issue resolution, and enrollment-related requests.
• Investigates and resolves enrollment discrepancies, and enrollment disconnects affecting providers and facilities.
• Maintains current knowledge of federal, state, Medicare, Medicaid, commercial payor, and managed care enrollment requirements and regulatory changes. Participates in continuous process improvement initiatives to enhance enrollment efficiency and effectiveness.
• Generates and maintains enrollment reports, approval tracking logs, performance metrics, and other data necessary to monitor enrollment Activities and organizational compliance.

Requirements

Minimum Qualifications

• High School Diploma or G.E.D.
• Two (2) years in Payer Enrollment role or equivalent healthcare insurance-related experience.
• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.

Preferred Qualifications

• One (1) year of experience with a Federally Qualified Health Center.
• Knowledge of Medicare, Medicaid, and commercial payor enrollment processes.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

Transportation

• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.