Payor Enrollment Specialist Full Time

Position Goal

Maintain a proper understanding of payor credentialing requirements as well as Athena enrollment functions to ensure accuracy. Serve as primary contact for payor credentialing inquires.

Position Responsibilities:
• Complete and maintain all CAQH/PECOS profiles for all providers.
• Complete timely follow up on all payer enrollment applications.
• Complete and coordinate paperwork for ERA, EDI, EFT, and other electronic channels between 
the organization and payers in the electronic billing system, and with enrollment services.
• Ensure that payer e-credentialing and revalidations are completed timely to prevent any lapse in 
enrollment.
• Load and maintain enrollment approvals and effective dates in Athena and enrollment system 
timely. 
• Communicate with payers, providers, and other entities to quickly and accurately obtain or 
provide information beneficial to the enrollment needs of the organization.
• Maintain knowledge of current health plan and agency requirements for credentialing/enrollments.
• Ensure practice addresses are current with government and commercial health plans, agencies and 
other entities by continuously updating rosters as payer directories. 
• Maintain confidentiality of provider information.
• Terminate enrollment with government and commercial payers upon resignation or termination of 
providers.
• Update and maintain National Provider Identification files for providers.
• Use the electronic billing system, along with any of the organization’s proprietary spreadsheets or 
software, purchased or leased, as the primary source of immediate notification and maintenance of 
enrollment related data.
• Respond to the enrollment services dashboard tasks and overall maintenance and content. 
• Monitor worklists to identify increases in accounts receivable or claims denials related to 
enrollment and credentialing issues and work towards resolution.
• Responsible for the day-to-day follow-ups for enrolled providers across Hughston’s enterprise. 
This includes enrollments for 50 various clinics, affiliated hospital and/ or surgery center
locations throughout GA, AL, TN, FL.
• Assist in other credentialing, licensing, privileging items as needed.

Experience:

Required:

• One year of direct payor enrollment experience or three years of related credentialing experience in a large medical clinic/hospital setting or in a payor setting

Education:

Required:

• High School Diploma or equivalent.

Preferred:

• Advanced degree in related field.
• Provider Enrollment Specialist Certification (PESC).

Special Qualifications:

Required:

• Annual MVR may be required per policy and procedure; background reports may be ran as needed 
  throughout the course of employment. 
• Ability to work independently with minimal supervision. 
• Requires skill in computer systems and applications.
• Must have outstanding organizational and oral/written communication skills.
• Must be able to prioritize work to meet deadlines despite frequent interruptions.
• Ability to work in a team environment. 
• Must be able to prioritize tasks and use good professional judgment in assigned duties

Must be able to prioritize tasks and use good professional judgment in assigned dutiesThe Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.