Senior 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 two years, we’ve launched our platform, built an all-star team, powered hundreds of great companies, and served thousands of healthcare providers across the industry. To date, Medallion has saved over 250,000 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 Senior 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 on their own with little oversight from their lead or manager. The Senior Payer Enrollment 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. The Specialist works under the direction of their Team Lead.

This role reports to one of the Payer Enrollment Team Leads and base compensation for this role may land between $25-$35 per hour. In addition to base salary, Medallion offers equity, and benefits as part of the total compensation package. Many factors are considered when determining pay including: market data, geographic location, skills, qualifications, experience, and level.

Responsibilities:

• Complete health plan enrollment requests from application retrieval thru notifying clients upon request completion. This includes group and individual applications with Medicare, Medicaid, commercial and managed care health plans
• Develop, update, and maintain SOPs and workflows as needed
• Ensure Medallion has all supporting documentation in provider profiles. This includes all onboarding documents, application copies, welcome letter, and other correspondence
• Use solid critical thinking skills to analyze high-level issues and find timely solutions with long-term success
• Create client updates and participate in client calls as needed
• Follow up on enrollments in process (telephone, email, and portal) and maintain enrollment records in Medallion thru timely documentation
• Perform other duties as assigned
• Participate in short and long wide initiatives with the ability to project manage across various teams when needed
• Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations
• Establish close working relationships with payer representatives and contracting departments in order to streamline future submissions and improve approval times
• Submit selected applications to be audited, working toward 100% accuracy and not needing any applications to be audited, for both individual provider applications and group applications
• Research payer issues, including new payers and managed care payers, with little oversight from lead/manager, and work to resolve issues quickly and effectively so issues do not return
• Strong understanding of the Medicaid enrollment process for both individual providers and groups, including but not limited to revalidations, medical license expirations, deactivations, NPI taxonomy importance, complex entity ownership models

Skills and Requirements:

• Able to communicate well with a wide variety of internal and external contacts at all levels of the organization
• Expertise in using GSuites tools include GSheets, GDocs, and GMail
• 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
• Familiarity with payer enrollment related applications and processes. Typically this is seen with at least 4+ years of direct experience with enrollments
• Detail oriented and able to ensure the complex enrollment packages are complete and correct