Senior Payer Enrollment Specialist

Job not on LinkedIn

🔥 3 hours ago

🇺🇸 United States – Remote

💵 $55k - $65k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.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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Shady Grove Fertility

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

🏥 Healthcare

🧘 Wellness

Consulting • Healthcare • Wellness

Shady Grove Fertility is a network of reproductive medicine clinics that provides comprehensive fertility care and family-building services. The organization offers treatments including in vitro fertilization (IVF), intrauterine insemination (IUI), frozen embryo transfer (FET), egg freezing, donor gamete and embryo services, gestational carrier/surrogacy support, preimplantation genetic testing, and oncofertility services. Shady Grove emphasizes personalized, relationship-based care, accepts major insurance and financing options, operates dozens of locations across the U. S. , and supports LGBTQ+ and single-parent family building through specialized programs such as shared-risk IVF and patient education and support resources.

📋 Description

• Manage initial and recredentialing payer enrollment for groups, facilities, physicians, and APPs across insurance plans • Coordinate the addition of new service locations and maintain accurate payer contract participation • Manage monthly payer roster submissions and maintain efficient enrollment workflows, policies, and procedures • Utilize payer portals, including Availity, UHC, Kaiser, and LexisNexis, to manage enrollment and provider data • Maintain accurate provider, practice, and group information across NPPES, CAQH, payer portals, and directories • Conduct quarterly provider data attestations and validate demographic and participation information • Audit enrollment activities and documentation for accuracy, compliance, and adherence to established processes • Research and resolve payer enrollment issues while ensuring provider information meets payer and organizational requirements • Coordinate malpractice insurance certificates and annual Certificates of Insurance renewals • Support, train, and mentor the payer enrollment team while contributing to departmental initiatives and special projects • Identify and implement process improvements that enhance enrollment efficiency, accuracy, and overall team performance

🎯 Requirements

• An associate degree and three years of payer enrollment experience, or five years of experience in lieu of a degree • Bachelor’s degree preferred • Prefer CPCS, CPES, RHIA, or RHIT certification; CPCS required within two years if not already certified • Knowledge of payer enrollment, provider participation, and applicable regulatory requirements • Proficiency with Microsoft Office, CAQH ProView, NPPES, OIG, and payer portals • Strong attention to detail, organization, and documentation skills • Effective and professional communication with internal and external stakeholders • Ability to maintain confidentiality when handling sensitive provider and organizational information • Ability to research and resolve payer enrollment and provider data issues effectively • Ability to manage multiple priorities and deadlines in a fast-paced environment • Strong customer service, problem-solving, teamwork, and adaptability

🏖️ Benefits

• Medical, dental, and vision insurance • 401(k) with company match • Tuition assistance and professional development support • Performance-based bonus opportunities • Generous paid time off, paid holidays, and paid parental leave • Life and disability benefits • Fertility Discount Program • Employee wellness and recognition programs

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