Account Representative, Provider Enrollment – payer portals exp. req.

Role Overview

• Act as the primary contact for assigned accounts across multiple states
• Independently manage the full credentialing and provider enrollment process
• Complete and track provider enrollment applications with commercial and managed care payers
• Maintain and update payer portals to ensure accuracy and timely contract execution
• Coordinate contracting processes with payers, resolving issues and escalating delays
• Support Medicare and Medicaid enrollments
• Navigate state-specific processes unique to each payer and state
• Communicate with payers and providers to meet enrollment and contracting needs
• Keep clients informed with regular progress meetings and proactive problem-solving
• Ensure accuracy of provider data, including up-to-date CAQH profiles

Requirements

• Direct provider enrollment experience required
• Experience in submitting individual enrollment applications for billable providers required
• Experience with payer portals across commercial, managed care, Medicare, and Medicaid required
• Background in provider relations, payer contracting, or revenue cycle management
• Experience with nonprofit clinics, FQHCs, and/or private practices required
• Proficiency with credentialing/enrollment software and Microsoft Excel required

Benefits

• Health Insurance
• 401k w/ match
• Paid Holidays
• Paid Time Off