Sr. Payer Enrollment Systems Administrator
Full-Time - Revenue Cycle Billing Operations
Summa's Corporate Office
Summary:Acts as both the strategic lead for provider enrollment operations and the designated system administrator for Summa Health's credentialing, enrollment software platforms, and Medicare administrative portals. Responsible for overseeing complex network enrollment processes, managing primary source verification databases, and auditing system data to maximize electronic billing efficiency while simultaneously preventing revenue leakage across all hospital TINs and NPIs. In addition to day-to-day strategic enrollment operations, this position serves as the designated administrator for Medicare Provider Enrollment (PECOS), the HIPAA Eligibility Transaction System (HETS) EDI enrollment, and the My CGS Medicare Administrative Contractor portal. Will be the point person from Revenue Cycle to support the organization's compliance efforts related to new CMS mandates including the HETS NPI attestation requirement and provider-based NPI attestation requirements for off-campus outpatient departments.
Minimum Qualifications: 1. Formal Education Required:
a. Bachelor's degree in Business Administration, Healthcare Administration, Health Information Management, or a related field.
b. In lieu of a Bachelor's degree, Associate's degree with a minimum of two (2) years of progressive payer enrollment experience may be considered. Bachelor's degree is strongly preferred.
2. Experience & Training Required:
a. Five (5) years of progressive payer enrollment and credentialing experience in a hospital system or large healthcare organization required; 7+ years preferred.
b. Demonstrated hands-on experience as a system administrator or super user for credentialing and enrollment software platforms.
c. Demonstrated hands-on experience working directly in Medicare PECOS including new enrollments, change-of-information submissions, revalidations, and multi-TIN management.
d. Experience managing payer enrollment across multiple Tax ID numbers simultaneously.
e. Experience with HETS EDI enrollment and/or HETS trading partner agreements strongly preferred.
f. Experience with My CGS or a comparable MAC portal (e.g., Novitasphere, WPS Portal) preferred.
g. Experience developing enrollment policies, procedures, and KPI frameworks for large groups or health systems.
h. Experience managing payer enrollment through a Tax ID transition, acquisition, or merger strongly preferred.
i. Experience with Ohio Medicaid PNM provider enrollment system preferred.
j. Familiarity with Epic Revenue Cycle payer setup, EDI enrollment workflows, and payer table configuration a plus.
3. Other Skills, Competencies and Qualifications:
a. In-depth understanding of Medicare enrollment regulations, CMS-855 forms, NPPES/NPI requirements, primary source verification standards, and provider-based attestation rules.
b. Advanced proficiency with online payer enrollment tools including Availity, payer-specific enrollment portals, Tricare, and Medicaid enrollment systems; working knowledge of EDI transaction standards (270/271, 835, 837).
c. Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and Adobe Acrobat Professional.
d. Demonstrated ability to develop and track KPIs, conduct Revenue Cycle audits, analyze denial trends, and drive process improvements to reduce write-offs and claim denials.
e. Strong analytical and strategic thinking skills; ability to identify NPPES/PECOS data discrepancies and proactively resolve them before they generate claim rejections or revenue leakage.
f. Excellent interpersonal and communication skills; proven ability to manage complex payer relationships and collaborate with hospital and medical group leaders, MAC representatives, and cross-functional internal teams.
g. Highly organized and detail-oriented; able to manage a high volume of concurrent enrollment applications, TINs, and payer relationships simultaneously.
h. Flexible and adaptable to evolving CMS regulatory requirements and organizational priorities; proven follow-through in a deadline-driven, high-stakes environment.
i. Ability to interact effectively with diverse populations, maintaining dignity and respect.
4. Level of Physical Demands:
a. Sedentary work. Position is remote; primarily computer-based with prolonged periods of sitting. Occasional lifting of up to 10 lbs. may be required.
$30.91/hr - $46.36/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.
- Basic Life and Accidental Death & Dismemberment (AD&D)
- Supplemental Life and AD&D
- Dependent Life Insurance
- Short-Term and Long-Term Disability
- Accident Insurance, Hospital Indemnity, and Critical Illness
- Retirement Savings Plan
- Flexible Spending Accounts - Healthcare and Dependent Care
- Employee Assistance Program (EAP)
- Identity Theft Protection
- Pet Insurance
- Education Assistance
- Daily Pay
