Payer Enrollment Specialist

About the Role:

The Payer Enrollment Specialist / Account Specialist is responsible for completing accurate and timely health plan enrollment requests on behalf of Medallion clients. In addition to handling payer enrollments, this role also involves managing multiple client accounts, ensuring overall client health, and maintaining compliance with SLA (Service Level Agreements) and SLO (Service Level Objectives).

The Specialist is expected to research and resolve payer or client-related questions regarding submitted enrollments. They will use a combination of internal proprietary Medallion tools and standard communication methods (email, phone, fax, etc.) to complete tasks efficiently

Compensation for this role is between $19/hr - $27/hr depending on location and level. 

Responsibilities:

• Complete health plan enrollment requests from application retrieval through notifying clients upon request completion. This includes group and individual applications with Medicare, Medicaid, commercial and managed care health plans
• Follow up on enrollments in process (telephone, email, and portal) and maintain enrollment records in Medallion through timely documentation
• Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations
• Ensure Medallion has all supporting documentation in provider profiles. This includes all onboarding documents, application copies, welcome letter, and other correspondence
• Create client updates and participate in client calls as needed
• Establish close working relationships with payer representatives and contracting. departments in order to streamline future submissions and improve approval times
• Assist with revalidation processes to ensure provider participation in health plans remains active.
• Monitor and track payer enrollment timelines, deadlines, and ensure compliance with submission requirements.
• Investigate and resolve enrollment delays, rejections, or discrepancies by communicating with providers and payers.
• Maintain up-to-date knowledge of payer policies, state/federal regulations, and industry best practices for enrollment processes.
• Perform other duties as assigned

Skills and Requirements:

• Familiarity with payer enrollment-related applications and processes. Typically this is seen with at least 3+ years of direct experience with enrollments
• Expertise in using GSuites tools include GSheets, GDocs, and GMail
• Detail oriented and able to ensure the complex enrollment packages are complete and correct
• Able to communicate well with a wide variety of internal and external contacts at all levels of the organization
• Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization