Payer Enrollment Specialist
Remote
Integrated Operations /
Remote / Full Time Employee /
Remote
Plume Health is a passion-fueled, mission-driven company that is trans-founded and focused on radically increasing access to healthcare for the trans community, supporting a bold, authentic and healthy lifestyle. We hope to make gender-affirming hormone therapy easily accessible at the touch of a button in every state of the US. We are an organization by and for trans folks and we want heart-forward, awesomely talented teammates to join us on our journey.
This work is deeply personal and heart-driven, and we want teammates who, above all else, care about the mission and the people we serve. For the right candidates, we present a rare opportunity to do well by doing good. Plume offers an affirming, trans-centered, culturally inclusive and fun work environment filled with purpose.
About the Role:
The Payer Enrollment Specialist role is a vital position within our Credentialing and Contracting team, entrusted with overseeing all aspects of payer contracting lifecycle. Your deep passion for supporting the underserved trans community and eagerness to play a crucial role in broadening access to care are invaluable.
This role is a key part of our fee-for-service reimbursement strategy, offering a unique opportunity for motivated individuals to make an immediate and significant impact. As a Payer Enrollment Specialist, you'll be at the forefront of developing and executing our payer contract management initiatives, playing an integral role in fostering strong payer relationships and managing contracts efficiently, contributing significantly to the operational success of our organization. If this sounds like the right challenge for you, we encourage you to apply and join us in making a difference.
Responsibilities:
Payer Relationship Management:
• Build and maintain strong relationships with payer partners.
• Advocate for organizational interests and collaborate for mutual success.
• Drive performance improvement initiatives with internal teams and payer partners.
Contract and Rate Management:
• Maintain and update contract rates, including yearly governmental changes.
• Identify payment discrepancies and market trends to optimize collections.
Contract Review and Coordination:
• Assess initial contract terms for Operations and Finance.
• Review and summarize contract amendments.
• Coordinate document submission for new payer contracts.
Communication and Data Management:
• Communicate new payer developments to relevant departments.
• Manage payer dashboard access for new hires and terminated employees.
Interdepartmental Collaboration:
• Work across departments to solve contract/credentialing issues.
Additional Responsibilities:
• Undertake other duties as required for organizational support.
Must-Haves:
- A passion for and affinity with the mission of Plume, to transform healthcare for every trans life
- Proven track record in payer contracting and provider credentialing, with at least two years of experience.
- Manage the research, preparation, and submission of contract applications, including credentialing and enrollment forms as required by plans. Diligently track and report on the progress of each submission.
- Familiarity with various insurance plans and healthcare payment systems.
- Proficiency in managing relationships with insurance payers.
- Understanding of healthcare regulations, including HIPAA, and federal and state laws.
- Familiarity with the specifics of credentialing standards and processes.
- NCQA knowledge is a plus.
- Ability to effectively communicate with various stakeholders, including insurance representatives, healthcare providers, and team members.
- Skilled in both written and verbal communication.
- Ability to identify and resolve discrepancies and issues in payer contracts.
- Strong organizational and time-management skills, with an ability to prioritize tasks effectively.
- Demonstrated understanding and empathy towards the trans experience.
- Commitment to inclusivity and respectful communication.
- A degree in healthcare administration, business, or a related field.
- Certifications related to healthcare contracting or credentialing can be a plus.
- Familiarity with healthcare IT systems, credentialing databases (Salesforce), and GSuite.
- Ability to adapt to a changing healthcare landscape.
- Commitment to staying updated on industry trends and best practices.
- Ability to work collaboratively within a team, contributing positively to team dynamics.
Relevant Experience and Skills:
Knowledge of Healthcare Regulations:
Strong Communication Skills:
Analytical and Problem-Solving Abilities:
Organizational Skills:
Cultural Competency and Sensitivity:
Educational Background:
Technology Proficiency:
Adaptability and Continuous Learning:
Team Collaboration:
Compensation and Benefits:
- $60k - $70k DOE
- Ground-Floor Equity
- Competitive Benefits & Perks
- Free Plume Membership
$60,000 - $70,000 a year
Full-Time Employee Benefits and Perks:
All Full-Time Employees are Eligible for:
• Ground-Floor Equity (Series B)
• Free Medical, Dental, Vision on the first of the month after you start full-time work
• Unlimited PTO
• 11 paid holidays and company shut-down for a week in December
• 401(k)
• Free Plume and Mental Health Subscriptions
Everyone associated with Plume gets the major benefit of having the best coworkers you could imagine, if you love fiercely intelligent, heart-open, mission-driven collaborators.
Plume is an equal opportunity employer. Trans and gender-nonconforming individuals are strongly encouraged to apply, particularly those who identify as people of color. We positively encourage applications from suitably qualified and eligible candidates regardless of age, color, disability, national origin, ancestry, race, religion, gender, sexual orientation, gender identity and/or expression, veteran status, genetic information, or any other status protected by applicable law. We will provide reasonable accommodations to individuals with disabilities upon request. Please let us know if you require any accommodations to apply or interview for this position.
Only those legally authorized to work in the USA are eligible to apply.
Discover more about Plume at www.getplume.co and become part of our award-winning journey towards transforming healthcare for every trans life. Join us today in shaping the future of healthtech and LGBTQ+ care!
