Strategic Payer Enrollment Specialist

El Rio Community Health Center; Tucson (AZ); On-site; USD 55,000 - 75,000; Full time

Job summary

El Rio Health seeks a Payer Enrollment Specialist to coordinate provider and facility enrollment and re-enrollment with Medicare, Medicaid, and other payors. The role supports timely approvals and compliant processes across credentialing and enrollment workflows.

The candidate will monitor applications, resolve deficiencies, maintain records, and collaborate with credentialing, HR, compliance, and billing teams to ensure smooth provider participation and reimbursement.

Qualifications

• Education: High School Diploma or G.E.D.
• Experience: Two (2) years in Payer Enrollment role or equivalent healthcare insurance-related experience.
• Fingerprint Clearance Card: Level I card current, valid, and in good standing or applied within seven working days after starting.

Responsibilities

• Completes and submits provider facility enrollment and recredentialing applications to Medicare, Medicaid, commercial payors.
• Monitors enrollment status, follows up with payors, resolves deficiencies to ensure timely approvals.
• Maintains enrollment records, credentialing files, rosters, databases, and documentation per regulatory requirements.
• Processes and submits provider updates including demographics, locations, ownership, and NPI/CAQH data.
• Tracks revalidation and deadline dates to prevent lapses and denials.
• Coordinates with credentialing, medical staff, HR, compliance, and revenue cycle teams for enrollment and onboarding.
• Serves as primary contact for payors, providers, and internal staff on enrollment inquiries and status.
• Investigates enrollment discrepancies and disconnects affecting providers and facilities.
• Maintains knowledge of federal, state, Medicare/Medicaid and payor enrollment changes; seeks process improvements.
• Generates enrollment reports, approval logs, and performance metrics.

Skills

Payer enrollment experience

Education

High School Diploma or G.E.D.

Job description

El Rio Health seeks a Payer Enrollment Specialist to coordinate provider and facility enrollment and re-enrollment with Medicare, Medicaid, and other payors. The role supports timely approvals and compliant processes across credentialing and enrollment workflows.

The candidate will monitor applications, resolve deficiencies, maintain records, and collaborate with credentialing, HR, compliance, and billing teams to ensure smooth provider participation and reimbursement.