Provider Enrollment/Credentialing Coordinator

• The Provider Enrollment Credentialing Coordinator is responsible for the enrollment of healthcare providers with health plans to minimize the possibility of delay or non-payment of claims rendered by practitioners.
• Collect and maintain providers' credentials and supporting documentation for the purpose of enrolling individual providers with payers.
• Complete Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new providers.
• Update, monitor, and maintain CAQH for existing providers.
• Responsible for completing applications, re-credentialing applications, demographic updates and documents to each payer for processing.
• Research payers for information on processes to enroll providers.

• · Monitor and follow up on the status of applications for providers and track progress on all pending and completed application.
• Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released.
• Participate in the physician onboarding process supporting credentialing and enrollment application process.
• Research and resolve provider related enrollment issues and coordinate with colleagues when necessary.
• Maintain provider files for revalidation of Medicaid and Medicare enrollments.
• Ensure the timeliness of provider enrollments.
• Other Duties as assigned.

Qualifications

• Associates degree required, prefer a Bachelor’s degree plus previous hospital business office experience Excellent verbal and written communication skills.
• Exceptional organizational skills.
• Strong attention to detail.
• Ability to make independent decisions.
• Previous experience with files or data gathering.
• Ability to prioritize and organize multiple tasks Meet established production and quality goals.
• Communicate and work well in a team environment.
• Ability to learn new software programs quickly.