Specialist, Quality Control Payer Enrollment

About the Role:

As a Specialist, Quality Control Payer Enrollment at Medallion, you will ensure that payer enrollment files adhere to our stringent quality standards. We are looking for someone who is highly detail-oriented and able to maintain accuracy in a high-volume, fast-paced environment. This role is critical to our success, as you will be responsible for identifying errors or omissions in enrollment applications and taking corrective actions to maintain compliance with payer-specific guidelines.

Compensation for this role is between $24/hr - $31/hr depending on location and level.

Responsibilities:

• Review payer enrollment submissions to ensure data accuracy and compliance with payer-specific guidelines before submission.
• Verify that all required documents (licenses, certifications, etc.) are included and up-to-date in each enrollment file.
• Flag errors or omissions in applications and communicate with team members for quick resolution to prevent resubmission.
• Deliver real-time feedback on errors and quality issues to the enrollment team, helping maintain production flow.
• Maintain detailed records of errors, corrective actions, and trends to support ongoing quality improvements.
• Work closely with the enrollment team to address quality-related issues and ensure compliance without disrupting production timelines.
• Confirm that all submissions meet payer-specific compliance standards and documentation requirements, reducing the risk of rejections or delays.

Skills and Requirements: 

• 2+ years of payer enrollment experience with applications and processes
• 2+ years of quality control experience 
• Experience with CAQH, PECOS, Availity, and Medicaid (any state)
• Preferred but not required: PESC, CPCS, CPMSM, CPHQ
• Proficient in Microsoft Excel
• Strong Analytical skills: must be able to spot trends and identify outliers
• Obsessed with details: able to identify discrepancies in information, processes, and policies. 
• Effectively communicate with stakeholders at various levels. 
• Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization

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