Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all.

The Payor Enrollment Specialist is responsible for overseeing all aspects of provider and clinic site enrollment with payors, as well as the administration and management of payor contracts. This role emphasizes maintaining an up-to-date master list of all provider and clinic site enrollments, ensuring communication with payors, negotiating and maintaining payor contracts, ensuring compliance with regulatory standards, and supporting efficient billing operations. Additionally, this position collaborates with internal stakeholders to monitor contract terms, reimbursement updates, and payor policy changes to optimize revenue cycle performance.

Responsibilities:

Payor Enrollment Responsibilities:

• Manage the end-to-end enrollment process for healthcare providers and clinic sites with all payors.
• Prepare, submit, and track enrollment applications, ensuring timely approval and maintaining accurate records of enrollment status.
• Maintain and regularly update a comprehensive master list of provider and clinic site enrollments, accessible to relevant stakeholders.
• Ensure compliance with all regulatory and payor-specific requirements throughout the enrollment process.
• Serve as the primary point of contact for providers, clinics, and payors to address and resolve enrollment-related issues.

Maintenance and Reporting Responsibilities:

• Create and maintain a centralized, detailed master list of provider and clinic site enrollments, including NPI numbers, taxonomies, effective dates, and payor-specific information.
• Regularly audit the master list for accuracy and completeness, updating records as needed.
• Generate reports and provide updates to leadership on enrollment statuses and timelines.

Contract Negotiation Management Responsibilities:

• Support the negotiation of provider and clinic site contracts with insurance companies, ensuring terms align with organizational goals.
• Review and interpret contract terms, including reimbursement rates, service provisions, and compliance requirements.
• Maintain a contract database and ensure adherence to contract terms and deadlines.
• Act as a liaison to address contract-related inquiries from providers or insurance companies.

Collaboration and Communication:

• Work closely with the billing team to resolve issues related to provider or site enrollment delays.
• Facilitate communication between internal departments, providers, and insurance payors to ensure alignment.
• Provide regular updates to leadership on enrollment processes, challenges, and successes.

Education and Experience:

• Associate degree in healthcare administration, business, or a related field with relevant experience OR
• Relevant certifications (CPMSM or CPCS preferred) with or combined with equivalent years of experience OR
• Extensive hands-on experience (3-5+years) in provider enrollment, credentialing, or payor contracting without a formal degree.

• 3-5 years of experience in payor enrollment, credentialing, and contract management within a healthcare setting.
• Experience working with Federally Qualified Health Centers (FQHCs) (preferred).
• Proven experience coordinating provider enrollment and contract negotiations with insurance payors.
• Strong knowledge of healthcare regulations, compliance standards (CMS, HIPAA, NCQA), and payor policies.
• Proficiency in managing provider credentialing and enrollment processes using CAQH, PECOS, NPPES, and state Medicaid portals.

Required Skills and Abilities

• Strong knowledge of healthcare payor requirements, enrollment processes, and industry regulations.
• Proficiency in managing and maintaining databases and master lists.
• Familiarity with medical billing practices and compliance standards.
• Exceptional organizational skills with a strong attention to details
• Excellent communication and interpersonal skills for working with diverse stakeholders.
• Proven ability to multitask and prioritize in a fast-paced environment.

Self-motivated with the ability to work independently and collaboratively

Covid-19 and Booster Vaccinations requirements: 

All employees are required to be fully vaccinated for COVID-19, including "health-care" required boosters as a condition of employment, subject to limited exemptions. New employees are required to provide proof of being fully vaccinated for COVID-19 and boosted before the first day of employment. If you completed your primary series early boosters, but have not received the most recent booster, you will be required to get the most recent booster and mask until competed if hired.

Benefits Information:

Our benefits program is designed to protect your health, family and way of life. We offer a competitive Benefits Program that includes affordable health insurance and Health Reimbursement Accounts (HRA), Dental and Vision Insurance, Educational and Continuing Education Benefits, Student Loan Repayment and Loan Forgiveness, Retirement Plan, Group Life and AD&D Insurance, Short term and Long Term Disability benefits, Professional Fee Reimbursement, Mileage and Cell Phone Reimbursement, Scrubs Reimbursement, Loupes Reimbursement, Employee Assistance Programs, Paid Holidays, Personal Days of Celebration, Paid time off, and Extended Illness Benefits.

MCC is an equal opportunity employer.  We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances.