Payer Liaison

Allied Digestive Health; West Long Branch (NJ); On-site; USD 52,000 - 76,000; Full time

Job summary

Allied Digestive Health is seeking a detail-oriented Credentialing Specialist to coordinate provider enrollment and revalidation with commercial, Medicare, Medicaid, and other payers. You will monitor statuses, maintain accurate provider data, and support credentialing operations in a fast-paced office.

The role requires 2+ years in healthcare payer enrollment or related experience, strong communication, and proficiency with credentialing systems.

Qualifications

• 2+ years of healthcare payer enrollment, credentialing, revenue cycle, or related healthcare administration experience.
• High school diploma or equivalent; associate's or bachelor's degree preferred.
• Knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• CPMSM, CPCS, CPES, or related industry certification is preferred but not required.
• Strong communication and organizational abilities.

Responsibilities

• Coordinate provider enrollment, re-enrollment, and revalidation with commercial, Medicare, Medicaid, and other payers.
• Monitor enrollment status and follow up with payers for timely processing and approval.
• Maintain provider demographic, licensure, credentialing, and enrollment data in internal systems.
• Coordinate meetings with health plans and/or funders.
• Manage provider roster updates, contract participation changes, terminations, and location changes.
• Research and resolve enrollment-related claim denials and reimbursement issues.
• Ensure compliance with payer requirements, regulatory standards, and organizational policies.
• Generate enrollment status reports and communicate progress to stakeholders.
• Serve as a subject matter expert on payer enrollment processes and requirements.
• Utilize credentialing and practice management software.
• Provide administrative support to the Credentialing Department as needed.
• Maintain confidentiality of sensitive provider and organizational information.

Skills

Communication skills

Organizational skills

Multitasking

Problem-solving

Independent work

Customer service

Excel proficiency

MS Office

Education

High school diploma or equivalent

Associate's or Bachelor's degree preferred

CPMSM/CPCS/CPES certifications preferred

Tools

Credentialing software

Microsoft Office

Job description

Job Responsibilities

• Coordinate with vendor to prepare, submit, and track provider enrollment, re-enrollment, and revalidation applications with commercial, Medicare, Medicaid, and other third-party payers.
• Monitor enrollment status and follow up with payers to ensure timely processing and approval.
• Maintain accurate provider demographic, licensure, credentialing, and enrollment data within internal systems.
• Coordinate meetings with health plans and/or funders.
• Manage provider roster updates, contract participation changes, terminations, and practice location additions or closures.
• Research and resolve enrollment-related claim denials and reimbursement issues.
• Ensure compliance with payer requirements, regulatory standards, and organizational policies.
• Generate enrollment status reports and communicate progress to stakeholders.
• Serve as a subject matter expert regarding payer enrollment processes and requirements.
• Utilize credentialing and practice management software.
• Provide administrative support to the Credentialing Department as needed.
• Maintain confidentiality of sensitive provider and organizational information.

Qualifications & Skills

• Strong verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Ability to manage multiple tasks and prioritize work effectively.
• Strong problem-solving and follow-up skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Professional demeanor with strong customer service skills.
• Proficiency with Microsoft Office Suite, particularly Excel.
• Willingness to learn healthcare credentialing systems and payer portals.

Education & Experience

• High school diploma or equivalent; associate's or bachelor's degree preferred.
• 2+ years of healthcare payer enrollment, credentialing, revenue cycle, or related healthcare administration experience.
• Prior healthcare office, administrative, internship, or customer service experience required.
• Knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• Experience with credentialing, revenue cycle, or medical office operations.
• CPMSM, CPCS, CPES, or related industry certification is preferred but not required.

Work Environment

This position operates in a professional office environment and routinely uses standard office equipment, including computers, phones, scanners, and copiers.

Physical Demands

While performing the duties of this position, employees are regularly required to sit, stand, walk, speak, hear, and use hands for computer and office work. Occasional lifting of office supplies up to 20 pounds may be required.

Schedule

This is a full-time, in-office position. Standard hours are Monday through Friday based on organizational needs