Payer Relations Specialist

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👻 Score fantôme 16%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Ovation Healthcare

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 45 years

💼 Conseil

📦 Logistique

🏭 Fabrication

Consulting • Logistics • Manufacturing

Ovation Healthcare est un leader dans la fourniture de services partagés pour les hôpitaux indépendants et les systèmes de santé. Avec plus de 45 ans d'expérience, la société améliore la performance des hôpitaux et des systèmes grâce à des services tels que le conseil en leadership, la gestion de la chaîne d'approvisionnement, la gestion du cycle des revenus, les services technologiques et la gestion des soins cliniques. Ovation Healthcare se consacre à soutenir les besoins financiers et cliniques des hôpitaux tout en préservant leur concentration sur les soins aux patients et le bien-être de la communauté. Leurs programmes éducatifs et services de conseil visent à renforcer les opérations hospitalières, rendant la prestation des soins de santé plus efficiente et efficace.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

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