Payer Enrollment Specialist

🔥 21 hours ago

🇺🇸 United States – Remote

💵 $20 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Medallion

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2020

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

💰 $43M Series C - Medallion on 2025-08

Healthcare • Healthcare Insurance • SaaS

Medallion is an AI-powered healthcare operations company that provides a SaaS platform to automate provider credentialing, payer enrollment, licensing, privileging, and ongoing monitoring. The platform uses machine learning and real-time automation to extract and standardize data, manage payer-specific and state rules, run automated follow-ups, and ensure compliance with NCQA and TJC standards—reducing costs and accelerating provider onboarding. Medallion serves payers, provider groups, health systems, RCM organizations, and digital health companies with a focus on lowering administrative burden and improving network readiness.

📋 Description

• Oversee the end-to-end health plan enrollment process, from application retrieval to client notification, by coordinating with external vendor partners • Directly complete highly escalated enrollment requests as needed • Monitor in-process enrollments through consistent follow-up via telephone, email, and portal • Maintain thorough and timely documentation within Medallion systems • Maintain in-depth understanding of payer-specific enrollment requirements, prerequisites, required forms, completion standards, supporting documentation, and applicable regulations • Maintain supporting documentation in provider profiles, including onboarding documents, application copies, welcome letters, and related correspondence • Prepare client updates communicating enrollment status and progress • Build and maintain relationships with payer representatives and contracting departments • Support revalidation processes to maintain active provider participation in health plans • Track payer enrollment timelines and deadlines for compliance • Investigate and resolve enrollment delays, rejections, or discrepancies by coordinating with providers, payers, and vendor partners • Stay current with payer policies, state and federal regulations, and industry best practices • Perform other duties and responsibilities as assigned

🎯 Requirements

• Familiarity with payer enrollment-related applications and processes; typically at least 3+ years of direct experience with enrollments • Expertise in using GSuite tools, including Google Sheets, Google Docs, and Gmail • Detail oriented and able to ensure 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 foster good working relationships with others within and outside the organization