Payer Relations Specialist

HealthTech Partners Inc•Maplewood, NJ

About The Position

We are seeking a Payer Relations Credentialing Associate to assist with the process of enrolling healthcare providers with insurance companies, re-credentialing updating databases, and problem-solving enrollment issues to ensure timely and accurate network participation.

Requirements

Associate’s degree or equivalent experience in healthcare or business administration
Minimum of 4 years of credentialing and payer enrollment experience
Strong understanding of health insurance payors and reimbursement processes
Experience with credentialing/payor enrollment tracking software (Medallion or similar system)
Excellent written and verbal communication skills
Strong organizational and follow-up skills
Ability to analyze data and identify trends
Excellent attention to detail and accuracy
Energy and passion for increasing access to quality healthcare and improving the quality of life for individuals with Intellectual and Developmental Disabilities

Responsibilities

Application Management: Prepare and submit initial and renewal credentialing/enrollment applications for providers (physicians, facilities, etc.) with commercial and government payers.
Follow-Up: Proactively track and follow up on application statuses, ensuring timely processing and resolving delays.
Data Management: Maintain accurate provider data within internal and external protals and databases for contracted and non-contracted payers.
Liaison: Serve as a contact for providers, internal teams, and insurance companies regarding credentialing and enrollment.
Compliance: Ensure adherence to payer requirements, policies, and regulatory standards.
Issue Resolution: Troubleshoot contracting processing issues by collaborating cross functionally to develop solutions.
Monitoring: Track provider licenses, certifications, and insurance expirations.

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