Payor Enrollment Specialist

TRILLIUM HEALTH INC; City of Rochester (NY); Vor Ort; USD 32.000 - 48.000; Vollzeit

Zusammenfassung

TRILLIUM HEALTH INC in Rochester, NY is seeking a Payor Enrollment Specialist to sustain the organization’s financial health by maintaining timely, accurate enrollments with Medicaid, Medicare, Managed Medicaid, and commercial payors.

You will support provider onboarding and site readiness, maintain audit-ready enrollment documentation across EMR and payor portals, and collaborate with Billing, Credentialing, Compliance, Operations, and HR to resolve enrollment issues.

Qualifikationen

• Two years of experience in provider or payor enrollment, medical billing, credentialing support, or related revenue cycle work.
• Strong attention to detail with ability to manage multiple priorities and deadlines.
• Experience with NYS Medicaid enrollment (eMedNY) and Medicare enrollment (PECOS) and provider NPI requirements.
• Excellent written and verbal communication skills.
• Proficiency with EMRs, CAQH, payor portals, Microsoft Office, and enrollment reporting tools; Epic experience preferred.

Aufgaben

• Process provider, group, and site enrollments, revalidations, reinstatements, and updates with payors.
• Maintain enrollment records including NPIs, taxonomy codes, locations, and affiliations.
• Monitor enrollment timelines to prevent lapses in payor participation or billing interruptions.
• Coordinate with Billing, Credentialing, Compliance, Operations, and HR to resolve enrollment-related issues.
• Ensure enrollment data is accurate across EMR and payor portals.

Kenntnisse

NYS Medicaid enrollment (eMedNY) and M

Medicare enrollment (PECOS)

provider NPI requirements

FQHC/multi-site healthcare experience

Attention to detail

Written & verbal communication

EMRs, CAQH, payor portals, MS Office

Epic and enrollment workflows

Ausbildung

High school diploma or equivalent

Associate or Bachelor's degree preferred

Tools

Epic

Enrollment reporting tools

Jobbeschreibung

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Regular Full Time 259 Monroe Avenue, Rochester, NY 14607, Rochester, NY, US

11 days ago Requisition ID: 2084

Salary Range: $22.75 To $35.32 Hourly

Department: Finance

Position Type: Full-Time

FLSA:Non-Exempt

Job Summary

The Payor Enrollment Specialist supports the financial sustainability of our Article 28 Federally Qualified Health Center (FQHC) by maintaining timely, accurate, and compliant provider, group, and site enrollments with Medicaid, Medicare, Managed Medicaid, and commercial payors. This role helps prevent reimbursement delays, reduce enrollment-related denials, support provider onboarding and site readiness, and maintain audit-ready enrollment documentation across internal systems and payor portals.

Duties/Responsibilities

• Process provider, group, and site enrollments, revalidations, reinstatements, and updates with NYS Medicaid/eMedNY, Medicare/PECOS, Managed Medicaid, and commercial payors.
• Maintain provider enrollment records, including NPIs, taxonomy codes, locations, affiliations, ownership changes, and effective dates.
• Monitor enrollment and revalidation timelines to prevent lapses in payor participation or billing interruptions.
• Ensure alignment between credentialing approvals, licensure, and payor enrollment effective dates.
• Respond to payor requests for documentation, attestations, audits, and follow-up inquiries related to enrollment and maintenance.
• Partner with Billing, Credentialing, Compliance, Operations, and HR to resolve enrollment-related claim issues and support provider onboarding and site openings.
• Research and resolve claims denials or payment delays related to enrollment status, effective dates, payor configuration, or provider/site setup; identify root causes and communicate recurring issues to Revenue Cycle leadership for correction and prevention.
• Maintain centralized, audit-ready tracking tools and documentation for all enrollment activity, including application status, payor effective dates, revalidation deadlines, pending documentation, follow-up activity, and known reimbursement or claim-risk impacts
• Ensure enrollment data is accurate and consistent across internal systems (EMR, billing systems) and external payor portals.
• Report enrollment status, open items, revalidation deadlines, payor delays, unresolved risks, and escalation needs to Revenue Cycle leadership.
• Demonstrate commitment to Trillium's mission, vision, values, and respectful engagement with patients, employees, and visitors.
• Responsible for maintaining confidentiality of all patient, client, employee, protected and proprietary information.
• Employees are accountable for meeting the performance standards of their departments and must participate as requested in compliance audits and quality improvement plans.
• Required to participate in continuous improvement of job responsibilities and organizational or work processes to advance the organization or department.
• Other specific duties as assigned.

Required Skills/Abilities

• Working knowledge of NYS Medicaid enrollment ( eMedNY ), Medicare enrollment (PECOS), and provider NPI requirements.
• Experience working in an FQHC, Article 28 facility, or multi-site healthcare organization strongly preferred.
• Strong attention to detail with the ability to manage multiple priorities and deadlines.
• Effective written and verbal communication skills.
• Proficiency with EMRs, CAQH, payor portals, Microsoft Office applications, and centralized tracking tools required; experience with Epic and enrollment-related workqueues or reporting tools preferred.

Education and Experience

• High school diploma or equivalent required; associate or bachelor's degree preferred.
• At least two (2) years of experience in provider or payor enrollment, medical billing, credentialing support, revenue cycle operations or related field required.
• Experience working in an FQHC, Article 28 facility, or multi-site healthcare organization strongly preferred

Physical Requirements

Ability to sit for extended periods, use a computer and office equipment, view screens and written materials, communicate effectively, occasionally stand/walk/bend/reach, lift up to 10 pounds, and maintain focus during repetitive, deadline-driven work, with or without reasonable accommodation.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.