Department: Operations
Reports To: Director of Revenue Strategy & Efficiency
FLSA: Non-Exempt
Position Summary
The Payer Enrollment Specialist serves as the operational link between NMA’s payer strategy (in-network and out-of-network) and the organization’s ability to submit claims, support accurate adjudication, and receive reimbursement. This role is responsible for payer enrollment and participation activities associated with managed care agreements and other payer arrangements, including provider and group enrollment, Letters of Agreement (LOAs), roster submissions, and provider-to-group affiliations following contract execution.
Essential Duties & Responsibilities
In-Network Enrollment, Participation & Contract Execution
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Manage post execution payer enrollment and participation activities, including provider and group enrollment, roster submissions, and provider to group affiliation requirements.
Out-of-Network (OON) Participation Support & Payer Relationship Maintenance
Provider-to-Payer Affiliation (NPI/TIN Linking, Rostering, Attestation)
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Manage provider to payer affiliation activities, including roster management, provider demographic updates, and payer attestation requirements.
Government Enrollment (Medicare/Medicaid/DOL)
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Manage government payer enrollment and participation activities, including Medicare, Medicaid, and other applicable programs
IONM-Specific Enrollment and Participation Requirements
Directory Audits, Network Integrity & Silent PPO Prevention
Payer Portal Management, Data Integrity & Documentation
Troubleshooting & Denial Prevention
