Payer Enrollment Specialist - Multi-Clinic Impact

MainStreet Family Urgent Care; Birmingham, Northern (AL, KY); Hybrid; USD 52,000 - 72,000; Full time

Job summary

MainStreet Family Care in Birmingham, AL is seeking an experienced Facility Enrollment Specialist to manage payer enrollment, credentialing, and recredentialing for our clinic locations.

You will serve as the primary resource for enrollment with Medicare, Medicaid, commercial payers, and other health plans, collaborating with Revenue Cycle Management and Credentialing teams to ensure timely and accurate enrollment.

Qualifications

• Experience in healthcare credentialing, payer enrollment, or a related healthcare administrative function.
• Working knowledge of commercial payer, Medicare, and Medicaid enrollment processes.
• Experience working with payer portals and online enrollment systems.
• Strong organizational skills with the ability to manage multiple applications, deadlines, and payer requirements simultaneously.
• Strong attention to detail and ability to maintain accurate enrollment records.
• Ability to communicate effectively with insurance carriers, government agencies, and internal stakeholders.
• Ability to independently research and resolve payer enrollment issues.
• Proficiency with Microsoft Office applications and electronic tracking systems.

Responsibilities

• Manage initial payer enrollment and credentialing for new clinic locations.
• Manage recredentialing and revalidation requirements for existing clinic locations.
• Complete and submit facility-level enrollment applications for Medicare, Medicare DME, Medicaid, commercial payers, managed care organizations, and other health plans.
• Add new clinic locations to existing payer contracts and organizational/group enrollments as appropriate.
• Maintain facility demographic and enrollment information with payers, including addresses, tax identification numbers, NPIs, billing information, ownership information, and other required data.
• Manage payer enrollment changes associated with clinic openings, relocations, acquisitions, ownership changes, closures, and other organizational changes.
• Track enrollment applications through completion and perform timely follow-up with payers.
• Maintain accurate records of facility enrollment effective dates, renewal/revalidation dates, payer participation, and application status.
• Ensure required facility documentation remains current and available for payer enrollment and recredentialing.
• Serve as an authorized administrator for payer websites, enrollment systems, and insurance portals.
• Establish and maintain organizational access to payer portals and manage appropriate administrative permissions.
• Research and resolve payer issues related to facility enrollment, participation status, demographic information, or payer records.
• Coordinate with payer representatives to resolve enrollment discrepancies and outstanding application requirements.
• Maintain knowledge of payer-specific enrollment requirements and communicate significant changes to appropriate internal stakeholders.
• Coordinate payer updates related to facility licenses, CLIA certificates, accreditation, Medicare/Medicare DME enrollment, Medicaid enrollment, and other applicable facility credentials.
• Monitor expiration and renewal dates for documentation required to maintain payer enrollment.
• Assist with payer enrollment activities associated with changes in facility licensure, service offerings, laboratory status, ownership, or organizational structure.
• Support enrollment and credentialing activities associated with acquisitions and organizational expansion into new locations or markets.
• Maintain organized documentation to support payer audits, enrollment verification, and recredentialing activities.
• Partner with Revenue Cycle Management and Billing teams to investigate facility-level enrollment issues that may impact claims processing or reimbursement.
• Research payer enrollment issues associated with claim denials, non-participating status, incorrect location information, or effective-date discrepancies.
• Escalate payer enrollment barriers that could materially impact revenue or clinic operations.
• Provide enrollment status and effective-date information to internal teams as needed.
• Coordinate with Provider Credentialing when payer requirements involve both individual practitioners and clinic locations.
• Coordinate payer enrollment activities for new clinic openings.
• Develop and maintain payer enrollment timelines for new locations to support operational readiness.
• Assist with facility enrollment due diligence and transition activities related to acquisitions.
• Coordinate payer notifications and applications associated with changes of ownership, tax identification numbers, NPIs, legal entities, or facility names.
• Work with Operations, Revenue Cycle Management, Provider Credentialing and leadership to identify payer enrollment requirements before new locations begin seeing patients.

Skills

Healthcare credentialing

Payer enrollment

Revenue cycle management

Payer portals

Organization & multitasking

Attention to detail

Communication with insurers

Tools

Microsoft Office

Electronic tracking systems

Job description

MainStreet Family Care in Birmingham, AL is seeking an experienced Facility Enrollment Specialist to manage payer enrollment, credentialing, and recredentialing for our clinic locations.

You will serve as the primary resource for enrollment with Medicare, Medicaid, commercial payers, and other health plans, collaborating with Revenue Cycle Management and Credentialing teams to ensure timely and accurate enrollment.