Payor Enrollment Specialist - Harbin Clinic : Job Details

Payor Enrollment Specialist

Harbin Clinic

Job Location : Rome,GA, USA

Posted on : 2025-08-13T15:29:08Z

Job Description :
Job DescriptionPrimary Responsibilities:
  • Create provider records in the practice management system
  • Manage and complete provider enrollment applications
  • Maintain participation with managed care organizations as defined by Payer Contracting
  • Maintain participation with Medicaid and Medicare services including MA and CMO plans
  • Facilitate claims billing by maintaining payer assigned privileges and billing numbers in the practice management system
  • Maintain enrollment dashboard and payer enrollment table within practice management system
  • Complete electronic remittance advice (ERA) enrollments and prepare electronic funds transfer (EFT) documents for CFO signature
  • Collaborate with various insurance carriers, internal and external team members to resolve payer questions and issues.
  • Maintain documentation and reporting regarding provider enrollments in process within the credentialing database
  • Responsible for understand specific application requirements for each payer including pre-requisites, forms required, licensure, CLIA, supporting documentation and regulations.
  • Research payer enrollment guidelines as needed for non-contracted payers.
  • Provide enrollment status reports to management and key personnel
  • Responsible for claims follow up for denials and edits related to payer enrollment
  • Maintain referring provider billing table
  • Maintain DEA license within the practice management system
  • Set up departments in practice management
  • Enter department numbers in the practice management systems
    • Education Requirement:
    • Proficiency in Athena practice management highly preferred
    • A minimum of three to five years of relevant work experience in payer enrollment, credentialing, or claims billing/follow up required.
    • Must possess or be willing to develop general knowledge of CAQH, PECOS, and credentialing systems.
    Skill Requirement:
    • Must have strong computer skills
    • Excellent organizational skills
    • Excellent verbal and written communication skills.
    • Strong interpersonal skills including the ability to effectively communicate with persons internal and external the organization, including physicians and other staff.
    Attributes and Qualifications Requirements:
    • Ability to work independently
    • Ability to exercise judgement and make decisions
    • Ability to multi-task
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