Enrollment Coordinator

*PRESCREEN THAT NEEDS TO BE AT TOP OF EACH RESUME:
- Location at tope of resume
- Medicare experience? If yes, how many years of exp and a brief summary of exp
- Medicaid experience? If yes, how many years of exp and a brief summary of exp
- Brief summary of candidates excel experience



Onsite perks: great team environment (full team onsite) and full cafeteria

200 Highland Corporate Drive
Cumberland, RI 02864

POSITION SUMMARY:
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 CPMs) in regards to escalation notices.
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.


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 Client Field and Operations Management, in order to ensure integration of all processes.

Notes from Spotlight Call:
Position Title: Enrollment Coordinator
Department: Payer Enrollment Government Payers (Medicare/Medicaid)
Location: On-site required due to physical mail handling


Key Responsibilities
Submit initial and revalidation applications for providers entering Clients
Handle government and/or commercial payer enrollment (Medicare/Medicaid)
Manage mail-based documentation and workflows

Ideal Candidate Profile
Experience:
Preferred: 12 years of experience with government payers (Medicare/Medicaid)
Not required: Candidates without direct experience will be considered if they show willingness to learn
Insurance experience is considered a strong transferable skill

Soft Skills:
Reliable and consistent attendance
Willingness to work on-site
Strong communication and organizational skills

Interview & Logistics
Interview Format: Microsoft Teams (virtual)
Interview Timeline: 12 business days after resume review
Rounds: Single interview round
Pre-Screening: Required; candidates should note any relevant experience or lack thereof clearly

Position Summary:

The Coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis. The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.

Duties:

Submits, maintains, and monitors applications for Initial enrollment and Revalidation with Government Medicaid Payer and Commercial Payers for Clinics and Providers in order to ensure active participation.
Provides assistance in developing and improving payer workflow while ensuring compliance with the company's regulatory, safety, quality, and confidentiality protocols and standards.
Responsible for ensuring the timely and accurate submission of Group and Provider enrollment applications for Medicaid and Commercial programs, supporting compliance and operational efficiency across payer relations.
Responsible for minimizing the deactivation of government program applications by adhering to established quality control procedures. Serves as a key point of contact for escalated claim issues received from internal departments, coordinating with payers to identify and implement solutions. Communicates resolutions and relevant updates to appropriate internal stakeholders to ensure alignment and continuity.

Experience:

At least 1 year of overall related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes or previous work experience in regulatory environment. Comfortable in both team player and team roles. Dependable/Responsible/Accountable Excellent spoken and written communication skills Capable of managing through transition, while fostering a positive team environment Confident in decision making ability within strict timelines Exceptional prioritization and organizational skills Acts with integrity and uses sound judgment in dealing with confidential information

Education:

High school diploma or GED required, Bachelors Degree in Business Administration, Marketing, Finance or similar field preferred and have 2+ years of relevant work experience.