Payer Enrollment & Credentialing Specialist

A position responsible for managing all aspects of payer enrollment and credentialing for approximately 400 providers across all Tennessee Orthopaedic Alliance (TOA) markets. This role oversees new provider onboarding with commercial and government payers, payer recredentialing, and ongoing updates to ensure continuous participation in payer networks. The specialist provides timely updates on enrollment status to operational and revenue cycle teams, works independently with minimal supervision, and partners with billing staff to resolve claims denials related to credentialing status.

Responsibilities

• Manages payer enrollment and credentialing for all TOA providers across multiple markets, including Medicare, Medicaid, and commercial payers.
• Coordinates and completes applications for new provider onboarding, ensuring accuracy and timely submission to prevent delays in payer effective dates.
• Oversees the recredentialing process with payers, ensuring compliance with payer timelines and preventing provider terminations.
• Provides real-time status updates on enrollment and recredentialing progress to operational leadership, market managers, and billing staff.
• Serves as the primary resource for enrollment-related issues, including resolving claims denials and assisting billing teams with payer communication.
• Maintains accurate records of enrollment status, effective dates, and payer correspondence in credentialing/enrollment databases.
• Develops and maintains relationships with payer representatives to expedite issue resolution and ensure up-to-date knowledge of payer requirements.
• Independently manages workload and prioritizes tasks for 400+ providers, balancing competing demands with minimal supervision.
• Collaborates with compliance, credentialing, and contracting teams to ensure alignment across provider data, contracts, and enrollment files.
• Provides reporting and dashboards for leadership on enrollment timelines, pending items, and provider participation status.
• Performs other related duties to support TOA’s payer contracting and credentialing functions.

Education: High school diploma or equivalent required. Associate’s or Bachelor’s degree in healthcare administration or related field preferred not required.

Experience: Minimum 2 years of experience in payer enrollment or credentialing required. Experience managing enrollment for large physician groups (200+ providers) strongly preferred. Familiarity with Medicare PECOS, CAQH, Medicaid, and commercial payer enrollment systems.

Skills & Competencies: Expert knowledge of payer credentialing/enrollment requirements. Strong organizational and time management skills to oversee 400+ active providers. Excellent written and verbal communication skills, with ability to provide concise, accurate updates. Proficiency with credentialing/enrollment databases and Microsoft Office Suite. Ability to work independently and resolve complex issues with little supervision.