Coordinator, Payor Enrollment at Pediatric Associates – Plantation, Florida

Remote Opportunity!

Schedule: Monday-Friday, 8am-5pm

PRIMARY FUNCTION

The Coordinator, Payor Enrollment is responsible for following established procedures for submitting and tracking all providers until they are appropriately tied to correlating PAFC entities and accurately represented with payor partners (including both Government programs and Commercial payors). This position works closely with the Managed Care and Credentialing teams, and reports to the Manager of Enterprise Credentialing.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

1. Responsible for timely submission, tracking, and completion of payor enrollments for all contracted payor partnerships, including but not limited to: Medicaid and Medicaid Managed Care Organizations, Medicare and Medicare Advantage plans, Commercial and Employer Group plans, Individual and Family/Marketplace plans, Independent Physician Associations (IPAs), and Clinically Integrated Networks (CINs).

1. Facilitates troubleshooting and follow-up to ensure effective relationships with PAFC payor partners. Responds to email and phone calls for enrollment follow-up, and facilitates resolution of issues related to licensing, demographic information, panel status, and broader credentialing data management. Updates CredStream, Availity, and other related systems accordingly to facilitate timely maintenance of payer contract requirements.

1. Navigates both electronic and paper applications, integrated software platforms (including Availity and other payor portals), and centralized data repositories to source information for provider enrollment needs.

1. Oversees new provider enrollments, changes (including but not limited to provider demographic changes), and provider termination submissions, when applicable.

1. Tracks and provides enrollment status reporting to internal stakeholders regularly.

1. Complies with federal, state, Center for Medicare & Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) standards throughout enrollment process.

1. Demonstrates excellent professional communication skills while interacting with colleagues, customer relations, and leadership to collect missing information or resolve issues.

1. Other duties as assigned.

QUALIFICATIONS

EDUCATION:

• High School Diploma or GED

EXPERIENCE:

• 1-2 years of relevant experience working within credentialing, payor enrollment, or related health care role. Knowledge of health plans and government programs encouraged.

KNOWLEDGE, SKILLS AND ABILITIES

• Detail oriented

• Service mindset

• Effective organizational skills

• Advanced Microsoft Office skills

• Effective oral and written communication skills

• Ability to manage multiple priorities and projects

• Strong interpersonal skills

• Ability to influence others

TYPICAL WORKING CONDITIONS

• Non-patient facing

• Full time remote.

• Must be U.S. based.

• Indoor Work

• Operating Computer

OTHER PHYSICAL REQUIREMENTS

• Vision

• Sense of sound

• Sense of touch