Ovation Healthcare

Compensation

Full Description

Welcome to Ovation Healthcare! At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions. The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior. We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork. Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit https://ovationhc.com. Summary: The Payer Enrollment Specialist is responsible for supporting clients throughout the enrollment lifecycle and setup to ensure alignment with contractual and compliance requirements. This role is responsible for enrolling healthcare providers with commercial and government payers, ensuring timely credentialing and participation in insurance networks to ensure timely and accurate credentialing and participation in payer networks. Duties and Responsibilities: • Manage the end-to-end provider enrollment process, including initial credentialing, recredentialing, revalidations, and payer contracting readiness. • Serve as a subject matter expert resource to clients on enrollment, best practices, and compliance requirements. • Prepare, complete, and submit enrollment for individual providers and healthcare facilities across a range of commercial and government payers, e.g., Medicare, Medicaid, private insurers. • Maintain accurate and up-to-date provider records, including CAQH profiles, NPI registration, state license verifications, and other required documentation. • Track enrollment status, renewal deadlines, and expirations; proactively follow up with payers to ensure timely processing and approvals • Communicate directly with clients, providers, payers, and internal teams to gather required documentation and resolve enrollment-related issues. • Update and maintain provider participation status within internal systems and credential databases. • Audit and maintain provider data in internal systems and credentialing databases- • Stay current with changes in payer requirements, healthcare regulations, and credentialing standards; apply this knowledge to client recommendations and internal processes. • Prepare and deliver regular status updates, dashboards, and reports to clients and internal leadership. • Lead or assist in enrollment audits and implement corrective action plans as needed. Qualifications: • Associate's or bachelor’s degree in healthcare administration, business, or related field preferred. • Minimum of 3 years of experience in provider enrollment, billing, credentialing, or client-facing healthcare services role. • Working knowledge of commercial and government insurance payers. • Proficiency in Microsoft Office Suite and credentialing/enrollment software systems (e.g., CAQH, PECOS, Availity). • Excellent communication and organizational skills with strong customer service.