Payer Enrollment Specialist / Account Specialist (Contract)

The Payer Enrollment Specialist / Account Specialist (Contract) is responsible for ensuring the accurate and timely processing of health plan enrollment requests on behalf of Medallion’s clients by closely partnering with their vendor. This role oversees and manages vendor performance to achieve timely, high-quality enrollments and personally completes highly escalated enrollments when necessary.

The Specialist will manage multiple client accounts, focusing on maintaining client health and satisfaction while ensuring compliance with Service Level Agreements (SLAs) and Service Level Objectives (SLOs). They will act as a subject matter expert in payer enrollment requirements, facilitate collaboration between internal teams, vendors, and payers, and proactively address barriers to successful enrollment.

Responsibilities:

• Oversee the end-to-end health plan enrollment process—from application retrieval to client notification—by coordinating with external vendor partners; directly complete highly escalated enrollment requests as needed.
• Ensure that all in-process enrollments are appropriately monitored through consistent follow-up (via telephone, email, and portal), and maintain thorough, timely documentation within Medallion systems.
• Maintain an in-depth understanding of payer-specific enrollment requirements, including prerequisites, required forms, completion standards, supporting documentation (e.g., DEA certificates, CVs), and applicable regulations.
• Ensure that all necessary supporting documentation is accurately maintained in provider profiles, including onboarding documents, application copies, welcome letters, and other related correspondence.
• Prepare client updates to communicate enrollment status and progress as required.
• Build and maintain strong working relationships with payer representatives and contracting departments to streamline future submissions and improve approval timelines.
• Support revalidation processes to maintain active provider participation in health plans.
• Track and monitor payer enrollment timelines and deadlines to ensure compliance with submission requirements.
• Investigate and resolve enrollment delays, rejections, or discrepancies by coordinating with providers, payers, and vendor partners.
• Stay current with payer policies, state and federal regulations, and industry best practices relevant to enrollment processes.
• Perform other duties and responsibilities as assigned.

Skills and Requirements:

• Familiarity with payer enrollment-related applications and processes, typically requiring at least 3+ years of direct experience with enrollments.
• Expertise in using Google Suite tools, including Google Sheets (GSheets), Google Docs (GDocs), and Gmail.
• Detail-oriented and capable of ensuring complex enrollment packages are complete and correct.
• Able to communicate effectively with a wide variety of internal and external contacts at all organizational levels.
• Must be able to work cohesively in a team-oriented environment and foster good working relationships with others both within and outside the organization.