Payer Enrollment Specialist

About Medallion

Healthcare is going through an unprecedented transformation towards digital care. Medallion provides the critical administrative infrastructure to make that change possible. Our platform enables organizations to license their providers in new states, verify existing credentials, and get in-network with health plans. In just over three years, our platform has become an industry standard powering hundreds of healthcare companies to reduce administrative burden for tens of thousands of providers across the country. To date, Medallion has saved over 500,000 administrative hours for our customers!

Founded in 2020, Medallion has raised $85M from world-class investors like Sequoia Capital, Google Ventures, Spark Capital, Optum Ventures, and Salesforce Ventures.

About the Role:

The Payer Enrollment Specialist is responsible for completing accurate and timely health plan enrollment requests on behalf of Medallion clients. The Specialist is also responsible for researching and resolving payer or client related questions related to their submitted enrollments. The Specialist will use a combination of internal proprietary Medallion tools and standard communication methods (email, phone, fax, etc..) to complete enrollments. From time to time, a Specialist may interact with Medallion clients and internal teams to improve processes and support new tool development. 

Compensation for this role is between $19/hr - $27/hr depending on location and level. 

Responsibilities:

• Complete health plan enrollment requests from application retrieval through notifying clients upon request completion. This includes group and individual applications with Medicare, Medicaid, commercial and managed care health plans

• Follow up on enrollments in process (telephone, email, and portal) and maintain enrollment records in Medallion through timely documentation

• Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations

• Ensure Medallion has all supporting documentation in provider profiles. This includes all onboarding documents, application copies, welcome letter, and other correspondence

• Create client updates and participate in client calls as needed

• Establish close working relationships with payer representatives and contracting. departments in order to streamline future submissions and improve approval times

• Assist with revalidation processes to ensure provider participation in health plans remains active.

• Monitor and track payer enrollment timelines, deadlines, and ensure compliance with submission requirements.

• Investigate and resolve enrollment delays, rejections, or discrepancies by communicating with providers and payers.

• Maintain up-to-date knowledge of payer policies, state/federal regulations, and industry best practices for enrollment processes.

• Perform other duties as assigned

Skills and Requirements:

• Familiarity with payer enrollment-related applications and processes. Typically this is seen with at least 3+ years of direct experience with enrollments

• Expertise in using GSuites tools include GSheets, GDocs, and GMail

• Detail oriented and able to ensure the complex enrollment packages are complete and correct

• Able to communicate well with a wide variety of internal and external contacts at all levels of the organization

• Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization