About this role
Role Overview
- Oversee the end-to-end health plan enrollment process—from application retrieval to client notification—by coordinating with external vendor partners; directly complete highly escalated enrollment requests as needed.
- Ensure that all in-process enrollments are appropriately monitored through consistent follow-up (via telephone, email, and portal), and maintain thorough, timely documentation within Medallion systems.
- Maintain in-depth understanding of payer-specific enrollment requirements, including prerequisites, required forms, completion standards, supporting documentation (e.g., DEA certificates, CVs), and applicable regulations.
- Ensure that all necessary supporting documentation is accurately maintained in provider profiles, including onboarding documents, application copies, welcome letters, and other related correspondence.
- Prepare client updates to communicate enrollment status and progress as required.
- Build and maintain strong working relationships with payer representatives and contracting departments to help streamline future submissions and improve approval timelines.
- Support revalidation processes to maintain active provider participation in health plans.
- Track and monitor payer enrollment timelines and deadlines to ensure compliance with submission requirements.
- Investigate and resolve enrollment delays, rejections, or discrepancies by effectively coordinating with providers, payers, and vendor partners.
- Stay current with payer policies, state and federal regulations, and industry best practices relevant to enrollment processes.
- Perform other duties and responsibilities as assigned.
Requirements
- Familiarity with payer enrollment-related applications and processes.Typically this is seen with at least 3+ years of direct experience with enrollments
- Expertise in using GSuites tools include GSheets, GDocs, and GMail
- Detail oriented and able to ensure the complex enrollment packages are complete and correct
- Able to communicate well with a wide variety of internal and external contacts at all levels of the organization
- Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization