Payer Enrollment Specialist will be responsible for managing and optimizing the hospital's payer enrollment processes, including but not limited to initial enrollment, revalidations, and other miscellaneous tasks as required by payers. This role involves ensuring accurate and timely enrollment with various payers, maintaining compliance, and collaborating with internal teams to enhance financial performance

1. Facilitate the enrollment and credentialing process with various payers, including government programs and private insurers.
2. Maintain up-to-date knowledge of payer regulations, guidelines, and requirements to ensure compliance.
3. Collaborate with internal stakeholders, including billing and coding teams, to resolve payer-related issues and streamline processes.
4. Perform thorough verification and validation of provider information to prevent enrollment delays and billing errors.
5. Stay informed about changes in healthcare policies, reimbursement rates, and coding standards that may impact payer enrollment.
6. Develop and maintain strong relationships with payer representatives to expedite and troubleshoot enrollment processes.
7. Generate reports and analyze data related to payer enrollment, providing insights to improve efficiency and revenue outcomes.
8. Participate in training sessions and workshops to enhance knowledge and skills related to payer enrollment and healthcare regulations.

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

1. Associate’s degree in healthcare administration, business, or a related field required.
2. Bachelor's degree in healthcare administration, business, or a related field preferred.
3. Prior experience in healthcare payer enrollment, credentialing, billing or related roles.
4. Strong understanding of healthcare regulations, payer policies, and reimbursement processes.
5. Excellent organizational and communication skills, with attention to detail.
6. Proficiency in using relevant software and databases for enrollment and data analysis.
7. Ability to work independently and collaboratively in a dynamic healthcare environment.
8. Must be able to read, write legibly, speak, and comprehend English.

WORKING CONDITIONS

WORK CONTEXT

• Coordinate and lead others
• Deal with external customers/vendors
• Provide business appropriate letters, memos, and emails
• Public speaking
• Work well within a group or team

• Freedom of decision making without supervision
• Understanding impact of decisions on the Health System
• Fast-paced and under time pressure

PHYSICAL FACTORS

• The Americans with Disabilities Act (ADA) requires the job description to document physical factors, including ability, activities, and requirements.
• Ability: Gross Body Equilibrium and Coordination.
• Activities: Talking, hearing, walking, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls.
• Requirements: Please indicate the physical requirements of the job as one of the following:
  • Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.

• Must be able to perform the duties with or without reasonable accommodation.
• Hearing and vision must be normal or corrected to within normal range.
• Physical presence onsite is essential.

OTHER JOB FACTORS

• Deductive reasoning, fluency of ideas, problem sensitivity, oral comprehension, oral expression, written expression, speed of closure.
• Achieve goals set forth in job, ability to adapt to surroundings and continuous change, attention to detail, initiative, independence, stress tolerance, leadership, integrity and cooperation.
• Ability to build relationships, create a support structure for those in the Health System, provide recognition to those achieving the accolades, and satisfy work task independently.