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Payer Enrollment Specialist

myLaurel

myLaurel

Remote
Posted on Thursday, May 23, 2024

About Us:

myLaurel is the leader in home-based acute care tailored to the needs of frail, elderly, and complex patients. Our innovative Recovery at Home, Rapid Advanced Care, and Acute Care at Home models provide unmatched utilization reduction and readmission prevention for high-risk populations. Utilizing an interdisciplinary team of telehealth physicians, in-home paramedics, and RN care managers, myLaurel ensures patients avoid the conventional acute care journey from ER to admission to post-acute care. The innovative care model creates dramatic cost savings, helps patients avoid hospital-acquired conditions, and radically improves the patient and caregiver experience.

myLaurel Health has three clinical service programs:

  • Rapid Advanced Care: on-demand in-home acute care
  • Acute Care at Home: hospital patients are discharged home, and advanced care is continued in the home while simultaneously providing transition care, reducing time in the hospital and significantly reducing readmissions
  • Recovery at Home: post-hospital discharge program

Summary Description
The Payer Enrollment Specialist is responsible for managing the enrollment and credentialing processes with various healthcare payers, ensuring the entity and healthcare providers are properly enrolled and credentialed to bill for services rendered. This role requires meticulous attention to detail, strong communication skills, and the ability to navigate complex payer requirements.

Key Responsibilities:

  • Initiate and manage the enrollment process for myLaurel entities.
  • Initiate and manage the enrollment process with healthcare payers for new providers and facilities.
  • Coordinate the completion and submission for enrollment applications and required documentation.
  • Monitor the status of enrollment applications and follow up with payers to ensure timely processing.
  • With the support of the Credentialing and Licensing Specialist, manage the credentialing and re-credentialing process for providers and facilities.
  • Collect and verify required documents, including licenses, certifications, and malpractice insurance.
  • Submit credentialing applications and track progress to ensure compliance with payer deadlines.
  • Communicate enrollment status and updates to Credentialing & Licensing Specialist and Sr. Director of People Operations.
  • Maintain accurate provider and facility information within the enrollment and credentialing systems.
  • Back-up support with medical licensing as needed.
  • Ensure compliance with applicable laws, regulations, and accreditation standards governing payer enrollment and credentialing processes.

Key Competencies

  • Knowledge of healthcare payer enrollment, credentialing, and provider relations.
  • Knowledge in Medicare/Medicaid payor enrollment.
  • Knowledge of word processing software, spreadsheet software, and database software.
  • Exceptional written and verbal communication skills.
  • Must be self-motivated and able to communicate well with others in person, via written communication, and telephonically.

Requirements

  • 5+ years of payer enrollment/credentialing experience.
  • Experience in PECOS/NPPES, CAQH as these applications are related to provider enrollment.
  • Experience working with multi-entities
  • Experience in medical licensing a plus

Special Considerations

  • Prolonged periods of sitting at a desk and working on a computer.

Location: Remote (East Coast Hours Monday - Friday 9:00 am to 5:00 pm)
Pay Range: $21-$23/hour