Facility Enrollment Specialist

MainStreet Family Care
Birmingham AL Full Time In-Person

MainStreet Family Care operates almost 70urgent care clinics across Alabama Georgia Florida and North Carolina with a focus on expanding access to quality healthcare in underserved and rural communities. Were growing and were building the team to do it right.

The Facility Enrollment Specialist is responsible for managing and maintaining payer enrollment credentialing recredentialing and related administrative requirements for the organizations clinic locations. This position serves as the primary resource for facility-level payer enrollment and ensures that clinic locations remain properly enrolled and credentialed with Medicare Medicaid commercial insurance carriers and other applicable health plans. This role works closely with Revenue Cycle Management Provider Credentialing Billing Operations and other internal teams to address payer enrollment issues that could affect a clinics ability to bill and receive reimbursement.

Responsibilities

Facility Enrollment & Credentialing

- Manage initial payer enrollment and credentialing for new clinic locations.

- Manage recredentialing and revalidation requirements for existing clinic locations.

- Complete and submit facility-level enrollment applications for Medicare Medicare DME Medicaid commercial payers managed care organizations and other health plans.

- Add new clinic locations to existing payer contracts and organizational/group enrollments as appropriate.

- Maintain facility demographic and enrollment information with payers including addresses tax identification numbers NPIs billing information ownership information and other required data.

- Manage payer enrollment changes associated with clinic openings relocations acquisitions ownership changes closures and other organizational changes.

- Track enrollment applications through completion and perform timely follow-up with payers.

- Maintain accurate records of facility enrollment effective dates renewal/revalidation dates payer participation and application status.

- Ensure required facility documentation remains current and available for payer enrollment and recredentialing.

Payer & Insurance Administration

- Serve as an authorized administrator for applicable payer websites enrollment systems and insurance portals.

- Establish and maintain organizational access to payer portals and manage appropriate administrative permissions.

- Serve as a primary point of contact for facility-specific payer enrollment and credentialing matters.

- Research and resolve payer issues related to facility enrollment participation status demographic information or payer records.

- Coordinate with payer representatives to resolve enrollment discrepancies and outstanding application requirements.

- Maintain knowledge of payer-specific enrollment requirements and communicate significant changes to appropriate internal stakeholders.

Regulatory & Facility Enrollment Maintenance

- Coordinate payer updates related to facility licenses CLIA certificates accreditation Medicare/Medicare DME enrollment Medicaid enrollment and other applicable facility credentials.

- Monitor expiration and renewal dates for documentation required to maintain payer enrollment.

- Assist with payer enrollment activities associated with changes in facility licensure service offerings laboratory status ownership or organizational structure.

- Support enrollment and credentialing activities associated with acquisitions and organizational expansion into new locations or markets.

- Maintain organized documentation to support payer audits enrollment verification and recredentialing activities.

Revenue Cycle Support

- Partner with Revenue Cycle Management and Billing teams to investigate facility-level enrollment issues that may impact claims processing or reimbursement.

- Research payer enrollment issues associated with claim denials non-participating status incorrect location information or effective-date discrepancies.

- Escalate payer enrollment barriers that could materially impact revenue or clinic operations.

- Provide enrollment status and effective-date information to internal teams as needed.

- Coordinate with Provider Credentialing when payer requirements involve both individual practitioners and clinic locations.

New Clinic & Acquisition Support

- Coordinate payer enrollment activities for new clinic openings.

- Develop and maintain payer enrollment timelines for new locations to support operational readiness.

- Assist with facility enrollment due diligence and transition activities related to acquisitions.

- Coordinate payer notifications and applications associated with changes of ownership tax identification numbers NPIs legal entities or facility names.

- Work with Operations Revenue Cycle Management Provider Credentialing and leadership to identify payer enrollment requirements before new locations begin seeing patients.

Qualifications

Required

- Experience in healthcare credentialing payer enrollment revenue cycle management or a related healthcare administrative function.

- Working knowledge of commercial payer Medicare and Medicaid enrollment processes.

- Experience working with payer portals and online enrollment systems.

- Strong organizational skills with the ability to manage multiple applications deadlines and payer requirements simultaneously.

- Strong attention to detail and ability to maintain accurate enrollment records.

- Ability to communicate effectively with insurance carriers government agencies and internal stakeholders.

- Ability to independently research and resolve payer enrollment issues.

- Proficiency with Microsoft Office applications and electronic tracking systems.

Preferred

- Experience working within a multi-location healthcare organization.

- Experience with urgent care physician practice ambulatory care or similar outpatient healthcare settings.

- Experience with Medicare PECOS/DME and state Medicaid enrollment systems.

- Familiarity with organizational NPIs Tax IDs CLIA certification facility licensing payer contracting and changes of ownership.

- Experience supporting payer enrollment for new clinic openings or healthcare acquisitions.