Job Family:

Travel Required:

Clearance Required:

The Payer Enrollment Specialist is responsible for ensuring the timely and accurate enrollment of healthcare providers with major insurance vendors for a moderately sized medical group. This position manages payer enrollment functions and coordinates closely with the medical credentialing team for provider updates, resolves enrollment issues, and manages delegated provider rosters to ensure compliance with insurance payer requirements.

What You Will Do:

Payer Enrollment and Compliance:

• Complete and manage payer applications for initial enrollment and re-enrollment, ensuring compliance with organizational standards and regulatory requirements.
• Coordinate with insurance payers to maintain accurate provider enrollment records for both government and commercial payers.
• Develop and distribute monthly delegated provider rosters, ensuring all provider status information remains current and accurate.

Collaboration and Issue Resolution:

• Work closely with the medical credentialing team to ensure seamless updates for provider enrollments and terminations.
• Serve as a point of contact for payer enrollment inquiries and issues, providing timely support to both internal teams and external partners.
• Proactively identify and resolve enrollment-related issues with insurance payers to minimize delays and maintain provider compliance.

Data and Enrollment Management:

• Accurately enter, maintain, and update provider information in payer enrollment systems, following data standards.
• Utilize MD-Staff or similar software to track application statuses and ensure timely follow-up on pending enrollment requests.
• Regularly update tracking spreadsheets to monitor outstanding items, follow up as necessary, and provide enrollment reports to leadership and stakeholders.

Operational Support:

• Ensure all active providers are enrolled with relevant payers and submit timely updates for provider terminations or other changes.
• Generate reports on enrollment progress, compliance, and delegated roster updates, sharing findings with internal stakeholders and recommending improvements as needed.
• Complete all job-related duties as assigned to support the efficiency and success of the payer enrollment process.

What You Will Need:

•  High School Diploma / GED or 3 years of relevant equivalent experience in lieu of Diploma / GED.
• 1-3+ year's experience in office, business, operations, customer service or healthcare field.

What Would Be Nice to Have:

• Operational experience with MD-Staff or other payer enrollment software.
• Experience with delegated roster management for insurance payers.

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What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected].  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.