Payer Relations Specialist

🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Ovation Healthcare

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 45 years

💼 Consulting

📦 Logistics

🏭 Manufacturing

Consulting • Logistics • Manufacturing

Ovation Healthcare is a leading provider of shared services for independent hospitals and health systems. With over 45 years of experience, the company enhances hospital and system performance through services like leadership advisory, supply chain management, revenue cycle management, technology services, and clinical care management. Ovation Healthcare is dedicated to supporting the financial and clinical needs of hospitals while preserving their focus on patient care and community wellness. Their educational programs and consulting services aim to strengthen hospital operations, making healthcare delivery more efficient and effective.

📋 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

🎯 Requirements

• 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

🏖️ Benefits

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