Senior Specialist, Payer Enrollment

About the role:

The Senior Payer Enrollment Specialist is responsible for completing accurate and timely health plan enrollment requests on behalf of Medallion clients. This role will be responsible for researching and resolving payer or client related questions on their own with little oversight from their lead or manager. This individual will use a combination of internal proprietary Medallion tools and standard communication methods (email, phone, fax, etc..) to complete enrollments. From time to time, a Specialist may interact with Medallion clients and internal teams to improve processes and support new tool development.

This role reports to one of the Payer Enrollment Team Leads and base compensation for this role may land between $23-$32 per hour. In addition to base salary, Medallion offers equity, and benefits as part of the total compensation package. Many factors are considered when determining pay including: market data, geographic location, skills, qualifications, experience, and level.

Responsibilities:

• Complete health plan enrollment requests from application retrieval thru notifying clients upon request completion. This includes group and individual applications with Medicare, Medicaid, commercial and managed care health plans
• Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations 
• Research payer issues, including new payers and managed care payers, with little oversight from lead/manager, and work to resolve issues quickly and effectively so issues do not return
• Strong understanding of the Medicaid enrollment process for both individual providers and groups, including but not limited to revalidations, medical license expirations, deactivations, NPI taxonomy importance, complex entity ownership models 
• Follow up on enrollments in process (telephone, email, and portal) and maintain enrollment records in Medallion thru timely documentation
• Submit selected applications to be audited, working toward 100% accuracy and not needing any applications to be audited, for both individual provider applications and group applications
• Ensure Medallion has all supporting documentation in provider profiles. This includes all onboarding documents, application copies, welcome letter, and other correspondence
• Create client updates and participate in client calls as needed
• Establish close working relationships with payer representatives and contracting departments in order to streamline future submissions and improve approval times
• Perform other duties as assigned

Skills and Requirements:

• 4+ years of payer enrollment experience, including group and individual applications with Medicare, Medicaid, commercial and managed care health plans
• Expertise in using GSuites tools include GSheets, GDocs, and GMail, Adobe Acrobat Pro
• 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

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