Payer Relations Specialist

🕒 Setembro 24

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👻 Score fantasma 12%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Ovation Healthcare

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 45 years

💼 Consultoria

📦 Logística

🏭 Manufatura

Consulting • Logistics • Manufacturing

A Ovation Healthcare é um fornecedor líder de serviços compartilhados para hospitais independentes e sistemas de saúde. Com mais de 45 anos de experiência, a empresa aprimora o desempenho de hospitais e sistemas através de serviços como consultoria em liderança, gestão da cadeia de suprimentos, gestão do ciclo de receita, serviços de tecnologia e gestão de cuidados clínicos. A Ovation Healthcare é dedicada a apoiar as necessidades financeiras e clínicas dos hospitais, preservando o foco no cuidado ao paciente e no bem-estar da comunidade. Seus programas educacionais e serviços de consultoria visam fortalecer as operações hospitalares, tornando a prestação de cuidados à saúde mais eficiente e eficaz.

Descrição

• Manage the end-to-end provider enrollment process, including initial enrollment, recredentialing, revalidation, and payer contracting readiness • Serve as a subject matter expert resource to clients on enrollment requirements, billing processes, payer setup, best practices, and compliance standards • Prepare, complete, and submit enrollment applications for individual providers and healthcare facilities across commercial and government payers, including Medicare, Medicaid, and private insurers • Maintain accurate and current provider records, including CAQH profiles, NPI registration, state license verifications, payer portal records, and other required documentation • Track enrollment status, renewal deadlines, expirations, recredentialing, and revalidation requirements; proactively follow up with payers to support timely processing and approvals • Communicate directly with clients, providers, payers, and internal teams to gather required documentation, resolve enrollment-related issues, and escalate barriers when appropriate • Update, audit, and maintain provider participation status and demographic data within internal systems and credentialing databases • Ensure payer setup and billing configuration meet contractual and regulatory requirements; advise clients on billing structure and enrollment implications • Stay current with changes in payer requirements, healthcare regulations, and credentialing standards; apply this knowledge to client recommendations and internal processes • Prepare and deliver regular status updates, dashboards, and reports to clients and internal leadership • Lead or assist with enrollment audits and support implementation of corrective action plans as needed

🎯 Requisitos

• Associate or Bachelor’s degree in healthcare administration, business, or a related field preferred • Minimum of 3 years of experience in provider enrollment, payer enrollment, billing, credentialing, or a client-facing healthcare services role • Proficiency in Microsoft Office Suite and credentialing/enrollment systems or payer portals, such as CAQH, PECOS, Availity, and related tools • Working knowledge of commercial and government insurance payers, including Medicare and Medicaid enrollment requirements • Strong attention to detail and ability to maintain accurate provider data, documentation, and enrollment records • Excellent written and verbal communication, organization, follow-up, problem-solving, and customer service skills • Ability to manage multiple priorities, meet deadlines, and work independently in a remote environment

🏖️ Benefícios

• Remote work arrangement • Collegial atmosphere of professionalism and teamwork • Opportunity to collaborate with highly skilled subject matter specialists and operations executives