{"id":1665334,"url":"https://alion.io/job/qualifacts-payer-enrollment-specialist","title":"Payer Enrollment Specialist","company":{"id":2084708,"name":"Quali Facts","domain":"qualifacts.com","url":"https://alion.io/company/qualifacts","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":null},"role":"Finance","role_family":"Finance","seniority":null,"employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Vadodara, India"],"countries":["IN"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":null,"experience_years_min":null,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"HIPAA","optional":false}],"status":"live","first_seen_at":"2026-08-24T00:00:00Z","employer_posted_date":"2026-08-24","last_verified_at":"2026-10-20T11:05:03Z","board_verified":true,"closed_at":null,"days_open":57,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":57},"description":"Job Description:\nEDI Enrollment Management:\nPrepare, submit, monitor, and maintain EDI enrollment requests for electronic transactions, including:Electronic Claims (837)\nElectronic Remittance Advice (ERA/835)\nElectronic Funds Transfer (EFT)\nClaim Status transactions (276/277), where applicable\nEligibility transactions (270/271), where applicable\n\nComplete payer-specific electronic enrollment applications through payer portals, clearinghouses, and paper enrollment processes, as required.\nCoordinate EDI enrollments with clearinghouses and insurance payers to establish electronic connectivity for assigned providers and client groups.\nValidate provider demographic information, National Provider Identifier (NPI), Tax Identification Number (TIN), billing information, and banking details before submission to ensure enrollment accuracy.\nTrack enrollment status, payer responses, effective dates, approvals, and activation milestones through completion.\nPayer & Clearinghouse Follow-up:\nPerform timely follow-up with insurance payers and clearinghouses to obtain enrollment status, resolve deficiencies, and expedite approvals.\nInvestigate and resolve rejected, delayed, or incomplete EDI enrollment requests.\nEscalate aging enrollments, payer delays, or connectivity issues that may impact claims submission or payment processing.\nMaintain consistent communication with internal stakeholders regarding enrollment progress, risks, and expected completion timelines.\nDocumentation & Quality:\nMaintain accurate documentation within enrollment systems, work queues, trackers, CMD records, and document repositories.\nDocument payer communications, enrollment approvals, rejection reasons, and corrective actions in accordance with RCMS documentation standards.\nEnsure all enrollment records are complete, current, and audit-ready.\nSafeguard sensitive provider and banking information while adhering to HIPAA and organizational security requirements.\nCross-Functional Collaboration:\nPartner with Credentialing, Billing, AR, Payment Posting, Client Success, Implementations, and U.S.-based teams to support provider onboarding and revenue cycle readiness.\nCoordinate with internal departments to resolve enrollment dependencies affecting electronic claims submission or payment processing.\nSupport new client implementations, provider onboarding, and organizational growth initiatives by ensuring timely EDI setup.\nIdentify process improvement opportunities to reduce enrollment turnaround times, improve first-pass approval rates, and standardize EDI workflows.\nAssist in training team members and sharing payer-specific EDI enrollment knowledge and best practices.\nQualifacts is an equal opportunity employer. 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