Payor Enrollment Specialist – Behavioral Health (Multi-State)

Precise Behavioral is hiring!

We are seeking a detail-oriented Payor Enrollment Specialist to join our team. The Payor Enrollment Specialist is responsible for end-to-end provider enrollment across multiple states for a behavioral health medical group. This includes psychiatrists, psychiatric NPs, therapists (LCSW), and other licensed clinicians delivering behavioral health services, both via telemedicine across state lines, and onsite services.

Precise Behavioral (Precise) was established to revolutionize the behavioral healthcare ecosystem for patients, providers, and health plans. Precise is a physician-owned and led organization that enables a mix of digital, telehealth, in-person, and community resources for improved patient outcomes.

Scope of service: This role ensures rapid provider onboarding, compliance with state and federal regulations, and timely reimbursement by managing enrollments with commercial payors, Medicare, and Medicaid (including telehealth-specific requirements).

Schedule: Monday through Friday 8am-5pm

Key Responsibilities:

• Manage enrollment for Psychiatrists (MD/DO), Psychiatric Nurse Practitioners (PMHNP), Therapists (LCSW, Psychologists).
• Execute multi-state enrollments across commercial plans (e.g., national carriers, Blues plans, regional MCOs), Medicare (including telehealth billing eligibility), Medicaid and Medicaid Managed Care Organizations (MCOs).
• Handle state-specific supervision/collaboration requirements (e.g., NP collaborative agreements where applicable).
• Ensure providers are enrolled correctly for Place of Service (POS 02 & 10), and Telehealth modifiers (e.g., 95, GT as required).
• Understand and manage cross-state licensure implications for telehealth delivery, payor-specific telehealth policies (varies widely by state and plan), validate that enrollments align with virtual care billing rules to prevent denials.
• Medicare & Medicaid Specialization Medicare enrollment via PECOS (CMS-855I/B/R forms), and multi-state Medicaid enrollments (high variability across states).
• Responsible for tracking revalidations, site/service location updates (critical for telehealth orgs).
• Navigate Medicaid nuances such as behavioral health carve-outs, state-specific tele-mental health rules.
• Commercial Payor Enrollment (Behavioral Health Focus), National carriers (e.g., UnitedHealthcare, Aetna, Cigna), Blues plans (state-specific), Behavioral health carve-outs (e.g., Optum Behavioral, Magellan).
• Understand differences between facility vs. individual enrollment, group vs. solo provider enrollment, track delegated vs. non-delegated arrangements.
• Partner with Recruiting & Clinical Ops to align enrollment timelines with provider start dates, reduce days to first billable appointment, revenue leakage from enrollment delays.
• Maintain dashboards tracking enrollment cycle times and payor activation status.
• Maintain and attest CAQH ProView profiles
• Ensure accuracy across NPI (Type 1 & Type 2), state licenses, DEA (for prescribing clinicians).
• Experience with credentialing/enrollment platforms (e.g., Modio, Verifiable, etc.)
• Ensure compliance with CMS telehealth guidelines, State Medicaid behavioral health policies, NCQA / URAC (if delegated credentialing applies).
• Maintain audit-ready documentation

Must-Have Expertise:

• Multi-state Medicaid enrollment (behavioral health)
• Medicare (PECOS) + telehealth billing alignment
• Commercial payor behavioral health networks
• Telehealth-Specific Competencies cross-state practice models, telehealth reimbursement rules
• Ability to identify enrollment errors that cause claim denials in virtual care settings
• High-volume, fast-paced enrollment execution
• Strong tracking and follow-up discipline
• Ability to manage ambiguity (common in telehealth scaling environments)

Qualifications:

• 3–6+ years of payor enrollment / credentialing experience
• Medicare + multi-state Medicaid experience is required
• Behavioral health provider enrollment is required
• Telehealth experience is strongly preferred
• Experience onboarding 50+ providers/year is required

This position offers the opportunity to work in a supportive environment where you can make a meaningful impact on the lives of individuals seeking mental health care.

Pay: From $27.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• end-to-end provider enrollment across multiple states for BH: 4 years (Required)
• Behavioral health provider enrollment: 4 years (Required)

Work Location: Remote