The Payor Enrollment Specialist supports the financial sustainability of an Article 28 Federally Qualified Health Center (FQHC) by maintaining timely, accurate, and compliant provider, group, and site enrollments with Medicaid, Medicare, Managed Medicaid, and commercial payors.
This role helps prevent reimbursement delays, reduce enrollment-related denials, support provider onboarding and site readiness, and maintain audit-ready enrollment documentation across internal systems and payor portals.
Duties and Responsibilities
- Process provider, group, and site enrollments, revalidations, reinstatements, and updates with NYS Medicaid/eMedNY, Medicare/PECOS, Managed Medicaid, and commercial payors.
- Maintain provider enrollment records, including NPIs, taxonomy codes, locations, affiliations, ownership changes, and effective dates.
- Monitor enrollment and revalidation timelines to prevent lapses in payor participation or billing interruptions.
- Ensure alignment between credentialing approvals, licensure, and payor enrollment effective dates.
- Respond to payor requests for documentation, attestations, audits, and follow-up inquiries related to enrollment and maintenance.
- Partner with Billing, Credentialing, Compliance, Operations, and HR to resolve enrollment-related claim issues and support provider onboarding and site openings.
- Research and resolve claims denials or payment delays related to enrollment status, effective dates, payor configuration, or provider/site setup; identify root causes and communicate recurring issues to Revenue Cycle leadership for correction and prevention.
- Maintain centralized, audit-ready tracking tools and documentation for all enrollment activity, including application status, payor effective dates, revalidation deadlines, pending documentation, follow-up activity, and known reimbursement or claim-risk impacts.
- Ensure enrollment data is accurate and consistent across internal systems (EMR, billing systems) and external payor portals.
- Report enrollment status, open items, revalidation deadlines, payor delays, unresolved risks, and escalation needs to Revenue Cycle leadership.
- Perform other duties as assigned.
Additional Information
- Department: Finance
- Position Type: Full-Time
- FLSA: Non-Exempt
Requirements & Qualifications
Required Qualifications
- High school diploma or equivalent required; associate or bachelor’s degree preferred.
- At least 2 years of experience in provider or payor enrollment, medical billing, credentialing support, revenue cycle operations, or a related field.
- Working knowledge of NYS Medicaid enrollment (eMedNY), Medicare enrollment (PECOS), and provider NPI requirements.
- Strong attention to detail with the ability to manage multiple priorities and deadlines.
- Effective written and verbal communication skills.
- Proficiency with EMRs, CAQH, payor portals, Microsoft Office applications, and centralized tracking tools.
- Experience with Epic and enrollment-related workqueues or reporting tools preferred.
Preferred Experience
- Experience working in an FQHC, Article 28 facility, or multi-site healthcare organization.
Location
New York, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago
Browse More Jobs