[Hiring] Specialist, Payer Relations @Ovation Healthcare

Role Description

The Specialist, Payer Relations supports clients throughout the provider enrollment lifecycle and advises on billing structure and payer setup to ensure alignment with contractual, regulatory, and compliance requirements. This role is responsible for enrolling healthcare providers with commercial and government payers, maintaining accurate provider records, monitoring enrollment status and deadlines, and helping ensure timely participation in payer networks.

Duties and Responsibilities

• Manage the end-to-end provider enrollment process, including initial enrollment, recredentialing, revalidation, and payer contracting readiness.
• Serve as a subject matter expert resource to clients on enrollment requirements, billing processes, payer setup, best practices, and compliance standards.
• Prepare, complete, and submit enrollment applications for individual providers and healthcare facilities across commercial and government payers, including Medicare, Medicaid, and private insurers.
• Maintain accurate and current provider records, including CAQH profiles, NPI registration, state license verifications, payer portal records, and other required documentation.
• Track enrollment status, renewal deadlines, expirations, recredentialing, and revalidation requirements; proactively follow up with payers to support timely processing and approvals.
• Communicate directly with clients, providers, payers, and internal teams to gather required documentation, resolve enrollment-related issues, and escalate barriers when appropriate.
• Update, audit, and maintain provider participation status and demographic data within internal systems and credentialing databases.
• Ensure payer setup and billing configuration meet contractual and regulatory requirements; advise clients on billing structure and enrollment implications.
• Stay current with changes in payer requirements, healthcare regulations, and credentialing standards; apply this knowledge to client recommendations and internal processes.
• Prepare and deliver regular status updates, dashboards, and reports to clients and internal leadership.
• Lead or assist with enrollment audits and support implementation of corrective action plans as needed.

Qualifications

• Associate or Bachelor’s degree in healthcare administration, business, or a related field preferred.
• Minimum of 3 years of experience in provider enrollment, payer enrollment, billing, credentialing, or a client-facing healthcare services role.

Knowledge, Skills, and Abilities

• Proficiency in Microsoft Office Suite and credentialing/enrollment systems or payer portals, such as CAQH, PECOS, Availity, and related tools.
• Working knowledge of commercial and government insurance payers, including Medicare and Medicaid enrollment requirements.
• Strong attention to detail and ability to maintain accurate provider data, documentation, and enrollment records.
• Excellent written and verbal communication, organization, follow-up, problem-solving, and customer service skills.
• Ability to manage multiple priorities, meet deadlines, and work independently in a remote environment.