Payor Enrollment Specialist

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. 
• Other specific duties as assigned.

Required Skills/Abilities:

• Working knowledge of NYS Medicaid enrollment (eMedNY), Medicare enrollment (PECOS), and provider NPI requirements.
• Experience working in an FQHC, Article 28 facility, or multi-site healthcare organization strongly preferred.
• Strong attention to detail with the ability to manage multiple priorities and deadlines.
• Effective written and verbal communication skills.
• Proficiency with EMRs, CAQH, payor portals, Microsoft Office applications, and centralized tracking tools required; experience with Epic and enrollment-related workqueues or reporting tools preferred.

Education and Experience:

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• At least two (2) years of experience in provider or payor enrollment, medical billing, credentialing support, revenue cycle operations or related field required.
• Experience working in an FQHC, Article 28 facility, or multi-site healthcare organization strongly preferred

Physical Requirements:

Ability to sit for extended periods, use a computer and office equipment, view screens and written materials, communicate effectively, occasionally stand/walk/bend/reach, lift up to 10 pounds, and maintain focus during repetitive, deadline-driven work, with or without reasonable accommodation.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.