Specialist, Payer Enrollment

Brentwood, TN - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Welcome to Ovation Healthcare!

At Ovation Healthcare weve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence we help rural healthcare providers fulfill their missions.

The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcares vision is to be a dynamic integrated professional services company delivering innovative and executable solutions through experience and thought leadership while valuing trust respect and customer focused behavior.

Were looking for talented motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives in a collegial atmosphere of professionalism and teamwork.

Ovation Healthcares corporate headquarters is located in Brentwood TN. For more information visit .

Summary:

The Payer Enrollment Specialist is responsible for supporting clients throughout the enrollment lifecycle and setup to ensure alignment with contractual and compliance requirements. This role is responsible for enrolling healthcare providers with commercial and government payers ensuring timely credentialing and participation in insurance networks to ensure timely and accurate credentialing and participation in payer networks.

Duties and Responsibilities:

Manage the end-to-end provider enrollment process including initial credentialing recredentialing revalidations and payer contracting readiness.
Serve as a subject matter expert resource to clients on enrollment best practices and compliance requirements.
Prepare complete and submit enrollment for individual providers and healthcare facilities across a range of commercial and government payers e.g. Medicare Medicaid private insurers.
Maintain accurate and up-to-date provider records including CAQH profiles NPI registration state license verifications and other required documentation.
Track enrollment status renewal deadlines and expirations; proactively follow up with payers to ensure timely processing and approvals
Communicate directly with clients providers payers and internal teams to gather required documentation and resolve enrollment-related issues.
Update and maintain provider participation status within internal systems and credential databases.
Audit and maintain provider data in internal systems and credentialing databases-
Stay current with changes in payer requirements healthcare regulations and credentialing standards; apply this knowledge to client recommendations and internal processes.
Prepare and deliver regular status updates dashboards and reports to clients and internal leadership.
Lead or assist in enrollment audits and implement corrective action plans as needed.

Qualifications:

Associates or bachelors degree in healthcare administration business or related field preferred.
Minimum of 3 years of experience in provider enrollment billing credentialing or client-facing healthcare services role.
Working knowledge of commercial and government insurance payers.
Proficiency in Microsoft Office Suite and credentialing/enrollment software systems (e.g. CAQH PECOS Availity).
Excellent communication and organizational skills with strong customer service.

Required Experience:

Welcome to Ovation Healthcare!At Ovation Healthcare weve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support guidance and tech-enabled shared services needed to...