Specialist-Payer Enrollment

Baptist Memorial Health Care Corporation; Memphis (TN); On-site; USD 40,000 - 64,000; Full time

Job summary

Baptist Memorial Health Care Corporation is seeking a Payer Enrollment Specialist to ensure accurate enrollment of providers with commercial and government payers. The role supports reimbursement timelines, provider scheduling, and regulatory compliance while coordinating with credentialing and billing teams.

The position requires attention to detail, proactive communication, and a minimum of 2 years in payer enrollment to maintain enrollment across payer portals and CAQH.

Qualifications

• 2 years of payer enrollment experience
• Experience with enrollment documentation and revalidations
• Knowledge of CAQH and payer-specific requirements

Responsibilities

• Verify required provider enrollment documentation with payers
• Submit enrollment applications for new providers and location changes
• Maintain up-to-date provider enrollment records
• Complete timely revalidation through CAQH and portals
• Follow up with payers to ensure timely processing
• Monitor enrollment timelines to avoid delays
• Address inquiries about enrollment status or payer requirements
• Coordinate with credentialing and billing teams
• Stay current on payer enrollment requirements
• Create and maintain enrollment documentation procedures
• Investigate and resolve claim denials related to enrollment issues
• Ensure provider data accuracy in payer systems
• Communicate enrollment status with payers

Skills

Attention to detail

Communication

Problem solving

Education

High School Diploma or GED

Medical Billing or Credentialing/Payer Enrollment certificate

Tools

CAQH

Payer portals

Job description

Overview

Job Summary

With direct impact on reimbursement timelines, patient satisfaction, and regulatory compliance, the Payer Enrollment Specialist plays a foundational role in healthcare administration. By ensuring timely and accurate enrollment of healthcare providers with commercial and government payers, this position directly contributes to the financial health of the organization and uninterrupted access to care for patients. Effective payer enrollment minimizes delays in reimbursement, supports provider scheduling, and ensures compliance with payer-specific and regulatory requirements. The specialist serves as a liaison between providers, internal departments, and payers to streamline application processing, manage revalidations, and resolve enrollment-related issues. Attention to detail, understanding of credentialing standards, and proactive communication are essential for success in this role.

Job Responsibilities

• Verify all required documentation for provider enrollment with insurance payers (e.g., applications, licenses, certifications).
• Submit enrollment applications and documentation required for both new providers, as well as location adds or practice changes
• Maintain and update records of provider enrollment status, ensuring that all information is accurate and up-to-date.
• Complete timely revalidation through payer portals, recredentialing applications, or profiles such as CAQH to ensure that providers maintain enrollment with commercial and governmental payers.
• Follow up with payers to ensure timely and accurate processing of provider enrollments within payer-specific turnaround time metrics, communicating directly with payer representatives to resolve enrollment issues or discrepancies, and escalating trends or new payer requirements to leadership
• Monitor payer enrollment timelines and ensure that all required steps are completed in a timely manner to avoid delays in provider participation.
• Address provider inquiries regarding enrollment status, billing issues, or payer-specific requirements.
• Coordinate with other internal departments (e.g., credentialing, billing) to ensure that enrollment information is aligned across systems.
• Research and maintain current knowledge of payer-specific enrollment requirements and changes, ensuring that provider data is compliant with payer guidelines.
• Support the creation and maintenance of documentation for payer enrollment processes and procedures.
• Monitor and Resolve Enrollment-Related Claim Denials: Investigate and resolve claim denials or rejections related to provider enrollment issues, including missing or incorrect NPI, TIN, or payer ID information.
• Maintain Accurate Provider Data: Ensure provider information is accurately reflected in payer systems to prevent claim processing delays or denials.
• Follow Up with Payers: Communicate with insurance payers to verify provider enrollment status and resolve any issues affecting claims adjudication.

Experience

• 2 years focused payer enrollment experience

Education

• High School/GED
• Medical Billing or Credentialing/Payer Enrollment certificate from an accredited facility.