Department:Finance
Position Type: Full-Time
FLSA:Non-Exempt
Job Summary:
The Payor Enrollment Specialist supports the financial sustainability of our Article 28 Federally Qualified Health Center (FQHC) by maintaining timely, accurate, and compliant provider, group, and site enrollments with Medicaid, Medicare, Managed Medicaid, and commercial payors. This role helps prevent reimbursement delays, reduce enrollment-related denials, support provider onboarding and site readiness, and maintain audit-ready enrollment documentation across internal systems and payor portals.
Duties/Responsibilities:
- Process provider, group, and site enrollments, revalidations, reinstatements, and updates with NYS Medicaid/eMedNY, Medicare/PECOS, Managed Medicaid, and commercial payors.
- Maintain provider enrollment records, including NPIs, taxonomy codes, locations, affiliations, ownership changes, and effective dates.
- Monitor enrollment and revalidation timelines to prevent lapses in payor participation or billing interruptions.
- Ensure alignment between credentialing approvals, licensure, and payor enrollment effective dates.
- Respond to payor requests for documentation, attestations, audits, and follow-up inquiries related to enrollment and maintenance.
- Partner with Billing, Credentialing, Compliance, Operations, and HR to resolve enrollment-related claim issues and support provider onboarding and site openings.
- Research and resolve claims denials or payment delays related to enrollment status, effective dates, payor configuration, or provider/site setup; identify root causes and communicate recurring issues to Revenue Cycle leadership for correction and prevention.
- Maintain centralized, audit-ready tracking tools and documentation for all enrollment activity, including application status, payor effective dates, revalidation deadlines, pending documentation, follow-up activity, and known reimbursement or claim-risk impacts
- Ensure enrollment data is accurate and consistent across internal systems (EMR, billing systems) and external payor portals.
- Report enrollment status, open items, revalidation deadlines, payor delays, unresolved risks, and escalation needs to Revenue Cycle leadership.
Miscellaneous
- Demonstrate commitment to Trillium’s mission, vision, values, and respectful engagement with patients, employees, and visitors.
- Responsible for maintaining confidentiality of all patient, client, employee, protected and proprietary information.
- Employees are accountable for meeting the performance standards of their departments and must participate as requested in compliance audits and quality improvement plans.
- Required to participate in continuous improvement of job responsibilities and organizational or work processes to advance the organization or department.
