Payor Enrollment Specialist

Payor Enrollment Specialist, QUADRANT BIOSCIENCES
Department: Payor Relations
Reports to: VP of Payor Relations

COMPANY

This is a fantastic opportunity to join a rapidly growing biotech company. Quadrant Biosciences works with top academic institutions, medical researchers and engineers to translate breakthrough findings into thoughtfully developed, scientifically sound applications. Our technology includes functional assessments and epigenetic biomarkers for neurological conditions such as concussion, autism spectrum disorder, and Parkinson’s disease. Quadrant Biosciences was recently highlighted on CNN, NPR, Bloomberg, and Huffington Post for its groundbreaking work.

JOB SCOPE

The Payor Enrollment Specialist will accomplish the following functions for billable employed physicians/ clinicians of QVC (Quadrant Virtual Care) and FBH (Frazier Behavioral Health). This position is primarily responsible for initiating and maintaining state and commercial payor credentialing of groups and physicians/clinicians in all states where QVC practices. This individual will work closely with provider credentialing and licensing to effectively navigate a variety of complex state and/or federal policies and requirements, which is critical to the operation of our medical and behavioral health service practice(s).

Responsibilities include, but are not limited to:

● Enters practitioner information into enrollment databases and ensures that the information in the databases is current and accurate.
● Regularly reviews CAQH records and verifies that all pertinent elements are captured in the databases and that it matches what is captured in the Credentialing database.
● Prepares initial and/or re-enrollment application packets, on behalf of the practitioner, for those payers who require a paper enrollment application.
● Ensures the enrollment packets are appropriately signed, complete and accurate, and submitted to the payer with necessary attachments.
● Coordinates re-enrollment dates and sends out application packets for all practitioners who require re-enrollment.
● Communicates with various payers, practitioners, and leadership regarding the status of enrollments on an ongoing basis as the primary contact for all enrollment issues.
● Will communicate with Managed Care on an ongoing basis as to the status of payer contracts and other various enrollment issues.

KNOWLEDGE, SKILLS AND ABILITIES

● Comprehensive knowledge of medical, clinical, and payor (both commercial and managed care) enrollment regulations and process
● Strong organizational skills, detail-orientation with the ability to prioritize
● Time management skills in a fast-paced environment
● Excellent Analytical skills to problem solving
● Strong communication both written and verbal
● Problem solving skills and ability to explore all options and use available resources to find new and effective solutions
● Strong organizational, critical thinking and problem-solving skills required
● Ability to communicate appropriately and effectively with providers; including sensitive and confidential information
● Must be able to prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
● Exhibits sound judgment and one who hold themselves up as a role model and mentor

WORK ENVIRONMENTS AND HAZARDS

This position requires sitting for extended amounts of time with a majority of tasks requiring typing at a computer station.

PHYSICAL DEMANDS

This position is mainly a stationary position involving sitting and standing for extended periods but may involve walking. Requires the ability to use computer screens and keyboards.

QUALIFICATIONS

Minimum Qualifications:
● Associate’s or bachelor’s degree in healthcare administration or other relevant field
● 3 years of payer enrollment experience with commercial, Medicaid, and managed care organizations.
● Experience with provider credentialing and enrollment databases (i.e., CAQH, NPPES, and PECOS)
● Proficiency in Google Workspace

Quadrant Biosciences Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.