About the Role

OpenLoop is looking for a Payer Enrollment Specialist to join our team remotely or at HQ in Des Moines, IA. In this role, you will be responsible for managing and streamlining provider enrollments with government and commercial insurance payers. This role is essential for ensuring compliance, optimizing credentialing processes, and maintaining provider relationships with Medicare, Medicaid, and private insurance networks.

What You'll Do

• Lead provider enrollment with Medicare, Medicaid, and commercial payers across all 50 states.
• Manage credentialing processes, including application submission, follow-ups, and ongoing compliance.
• Utilize CAQH and PECOS to verify provider credentials and maintain accurate enrollment data.
• Maintain up-to-date provider records, ensuring timely renewals and contract modifications.
• Communicate with payers, providers, and internal teams to resolve enrollment and credentialing issues.
• Ensure all provider data aligns with state and federal regulations, as well as individual payer requirements.
• Identify process improvements to enhance efficiency and reduce delays in provider onboarding.
• Stay informed about enrollment regulations and changes in payer policies affecting provider participation.
• Other duties as assigned

Who You Are

• 3– 5+ years in provider enrollment, credentialing, or payer relations.
• Strong familiarity with Medicare and Medicaid enrollment processes, along with commercial payer requirements.
• Proficiency in CAQH and PECOS for provider credentialing and enrollment.
• Exceptional attention to detail, organizational skills, and ability to manage multiple enrollments simultaneously.
• Strong verbal and written communication skills to liaise with providers and payers effectively.
• Comfortable working with enrollment software and maintaining digital records.