Payer Enrollment Specialist

Job Description: Qualifacts  is a leading provider of behavioral health software and SaaS solutions for clinical productivity, compliance and state reporting, billing, and business intelligence. Its mission is to be an innovative and trusted technology and end-to-end solutions partner, enabling exceptional outcomes for its customers and those they serve. Qualifacts’ comprehensive portfolio, including the CareLogic®, Credible™, and InSync® platforms, spans and serves the entire behavioral health, rehabilitative, and human services market supporting non-profit Certified Community Behavioral Health Clinics (CCBHC) as well as for-profit large enterprise and small business providers. Qualifacts has a loyal customer base, with more than 2,500 customers representing 75,000 providers serving more than 6 million patients.  Qualifacts was recognized in the 2022 and 2023 Best in KLAS: Software and Services report as having the top ranked Behavioral Health EHR solutions. This is an onsite position, 5 days/week, in the Vadodara office. Shift: -NIGHT/US SHIFT. 6:30pm-3:30am IST. Remote applicants will not be considered.  EDI Enrollment Management Prepare, submit, monitor, and maintain EDI enrollment requests for electronic transactions, including: Electronic Claims (837) Electronic Remittance Advice (ERA/835) Electronic Funds Transfer (EFT) Claim Status transactions (276/277), where applicable Eligibility transactions (270/271), where applicable Complete payer-specific electronic enrollment applications through payer portals, clearinghouses, and paper enrollment processes, as required. Coordinate EDI enrollments with clearinghouses and insurance payers to establish electronic connectivity for assigned providers and client groups. Validate provider demographic information, National Provider Identifier (NPI), Tax Identification Number (TIN), billing information, and banking details before submission to ensure enrollment accuracy. Track enrollment status, payer responses, effective dates, approvals, and activation milestones through completion. Payer & Clearinghouse Follow-up Perform timely follow-up with insurance payers and clearinghouses to obtain enrollment status, resolve deficiencies, and expedite approvals. Investigate and resolve rejected, delayed, or incomplete EDI enrollment requests. Escalate aging enrollments, payer delays, or connectivity issues that may impact claims submission or payment processing. Maintain consistent communication with internal stakeholders regarding enrollment progress, risks, and expected completion timelines. Documentation & Quality Maintain accurate documentation within enrollment systems, work queues, trackers, CMD records, and document repositories. Document payer communications, enrollment approvals, rejection reasons, and corrective actions in accordance with RCMS documentation standards. Ensure all enrollment records are complete, current, and audit-ready. Safeguard sensitive…