Job Family:

Patient Account Representative Credentials

Travel Required:

Up to 10%

Clearance Required:

None

Job Summary:

The Payer Enrollment Specialist is responsible for ensuring the timely and accurate enrollment of healthcare providers with major insurance vendors for a moderately sized medical group. This position manages payer enrollment functions and coordinates closely with the medical credentialing team for provider updates, resolves enrollment issues, and manages delegated provider rosters to ensure compliance with insurance payer requirements. This position is remote and based out of Birmingham, AL, specialist will need to be onsite for 1st two weeks and then once a week annually.

What You Will Do:

Payer Enrollment and Compliance:

Complete and manage payer applications for initial enrollment and re-enrollment, ensuring compliance with organizational standards and regulatory requirements.
Coordinate with insurance payers to maintain accurate provider enrollment records for both government and commercial payers.
Develop and distribute monthly delegated provider rosters, ensuring all provider status information remains current and accurate.

Collaboration and Issue Resolution:

Work closely with the medical credentialing team to ensure seamless updates for provider enrollments and terminations.
Serve as the primary point of contact for payer enrollment inquiries and issues, providing timely support to both internal teams and external partners.
Proactively identify and resolve enrollment-related issues with insurance payers to minimize delays and maintain provider compliance.

Data and Enrollment Management:

Accurately enter, maintain, and update provider information in payer enrollment systems, following data standards.
Utilize MD-Staff or similar software to track application statuses and ensure timely follow-up on pending enrollment requests.
Regularly update tracking spreadsheets to monitor outstanding items, follow up as necessary, and provide enrollment reports to leadership and stakeholders.

Operational Support:

Ensure all active providers are enrolled with relevant payers, and submit timely updates for provider terminations or other changes.
Generate reports on enrollment progress, compliance, and delegated roster updates, sharing findings with internal stakeholders and recommending improvements as needed.
Complete all job-related duties as assigned to support the efficiency and success of the payer enrollment process.

Skills:

Familiarity with payer enrollment processes and data management practices, with a strong focus on accuracy and compliance.
Strong verbal and written communication skills to interact effectively with internal teams and external partners.
Excellent organizational skills with a keen attention to detail to ensure accuracy across all enrollment documentation.
Ability to independently prioritize tasks and manage time efficiently in a high-volume, deadline-driven environment.
Demonstrated problem-solving abilities, critical thinking, and proactive approaches to overcoming payer enrollment challenges.
Familiarity with payer enrollment processes and data management practices, with a strong focus on accuracy and compliance.

What You Will Need:

High School Diploma or equivalent required.
1-3 years of experience in payer enrollment or a related role within healthcare billing or provider services.

What Would Be Nice To Have:

Operational experience with MD-Staff or other payer enrollment software.
Experience with delegated roster management for insurance payers.

The annual salary range for this position is $37,400.00-$56,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program

About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.