Enrollment Lead

Enrollment Lead

Requirements

• Bachelor’s degree in healthcare administration, business, or a related field.
• 3+ years of experience in payer enrollment, healthcare claims, commercial payers, and clearinghouse applications.
• Strong understanding of payer policies, enrollment processes, and compliance regulations.
• Excellent leadership and communication skills.
• Strong analytical and problem-solving skills.
• Detail-oriented with exceptional organizational abilities.
• Experience with electronic enrollment systems and healthcare IT solutions.
• Knowledge of healthcare reimbursement models and industry trends.
• Expert knowledge of electronic insurance setups and processes.
• Knowledge of accounts receivable and revenue cycle management.
• Ability to work independently and make sound and timely decisions.
• Excellent organizational, planning, and prioritization skills.
• Demonstrated ability to consistently follow documented processes or task workflows.
• Demonstrated ability to manage detailed tasks with accuracy and completeness.
• Ability to multi-task and manage ongoing task priorities.
• Advanced proficiency with Microsoft Office Suite Products.
• Experience using a CRM software solution (Salesforce).
• Experience with HME/DME software and providing customer service.

Responsibilities

• Lead the payer enrollment process, ensuring timely and accurate submissions of applications and required documentation.
• Communicate with healthcare providers to gather necessary documentation and information for enrollment or re-enrollment processes.
• Process incoming Enrollment requests for Commercial/Government insurance plans for new and existing clients serving as liaison between the client and the clearinghouse.
• Coordinate with clearinghouses to resolve any issues or discrepancies that arise during the enrollment process.
• Advise enrollment staff, providing training and guidance on enrollment processes.
• Provide training and support on the enrollment process, documentation requirements, and the use of the enrollment portals.
• Be the subject matter expert for the team for best practices, process and workflow definition, and documentation creation and maintenance related to enrolling with multiple clearinghouses.
• Identify and implement best practices to streamline enrollment processes with multiple clearing houses and reduce turnaround times.
• Analyze enrollment data to identify trends, challenges, and opportunities and inform decision-making.
• Work closely with internal teams and external stakeholders (e.g., payers) to resolve issues and improve enrollment outcomes.
• Ensure accurate maintenance of enrollment documentation.
• Complete deactivations of provider numbers, effective dates, NPI-related denials, NPI website, etc.
• Manage and complete product/service activation requests by following configuration steps and setting appropriate feature settings in the Brightree operating system.
• Respond to customer requests regarding system setup and activations.
• Accurately document interactions with customers and vendors in Salesforce following standard processes.
• Follow departmental procedures for case tracking and system updates.
• Process customer and internal escalations per department guidelines.

Preferred Qualifications

No preferred qualifications provided.