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Payer Enrollment Coordinator

Careers Integrated Resources Inc Cumberland, RI (Onsite) Contractor
Job Title: Payer Enrollment Coordinator
Location: Cumberland, RI 02864
Job Duration: 12+ Months 

Shift: Mon - Fri 7:30am - 4:00pm
Pay Range: $16.00 - $16.50/hr. on w2
 
Position Summary:
  • Provides administrative and operational support to network management and provider relations functions.
  • Assists with contract management, data analysis, provider directory maintenance, coordination of provider communication and education, and support of the resolution of operational issues.
  • Maintains accurate provider information, facilitating effective communication and ensuring smooth operations within the network management and provider relations department.
 
Role/Responsibilities:
  • The Payer Enrollment Coordinator will be responsible for ensuring corporate compliance with statutory requirements for Medicare, Medicaid, and Commercial enrollment for Clinics and Providers.
  • This Individual will have the ability to work well with others; collaboratively with internal and external vendors and create partnerships through effective relationship building skills.
  • This role will interact and work directly with new and existing Government /Commercial payers across the country. Analysis will include developing of provider and clinic level reporting insuring we are meeting all criteria for enrollment within our compliance policy for Government /Commercial.
  • Payer Enrollment Coordinator will interface and work directly with the Providers, and also with Payer Relations and Revenue Cycle Operations Teams (Credentialing, Accounts Receivable, Billing, and Call Center) Clinical Ops Teams, and MinuteClinic Field and Operations Management, in order to ensure integration of all processes.
  • This position is responsible, under the supervision of the Manager of the Payer Enrollment Dept. to:
  • Ensuring timely and accurate processing of Payer Enrollment applications (Initial and Revalidations) for Clinics and Providers.
  • Provide quality control for timely and accurate individual enrollment applications submitted for Medicare and Medicaid programs.
  • Resolve claims issues for individual payers in corporate billing system.
    Researching, completing and maintaining compliance with individual Government payers through credentialing, re-credentialing and audit processes and procedures.
  • Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. Interact with the field (SPM and CPM’s) in regards to escalation notices.
  • The Payer Enrollment Coordinator will be responsible for identifying and quantifying trends/issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be.
  • Minimize denials and deactivation of government applications where applicable to reduce key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt.
  • Update Credentialing and Billing systems with Provider information upon inquiry or receipt from Government /Commercial payers.
 
Required Skills:
  • 2-5 years’ work experience with Government payers
  • Adept at problem solving and decision-making skills
  • Ability to work independently
  • Proficient in Excel
  • Proficient in Outlook
  • Willingness to learn
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Job Snapshot

Employee Type

Contractor

Location

Cumberland, RI (Onsite)

Job Type

Other

Experience

Not Specified

Date Posted

07/14/2025

Job ID

25-51973

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