Credentialing and Enrollment Coordinator
Tasks
- Collect verify maintain provider credentials
- Complete submit payer enrollment applications
- Conduct background checks NPDB queries OIG SAM exclusion checks
- Coordinate enrollment effective dates with billing and revenue cycle
- Enroll providers with Medicare Medicaid and commercial payers
- Generate basic credentialing and enrollment reports
- Input provider information into credentialing and enrollment databases
- Link providers to group practices and tax ID numbers
- Maintain compliance with NCQA CMS and state credentialing standards
- Maintain update provider profiles in CAQH
- Manage communication with providers payers and related entities
- Perform primary source verification licenses certifications education
- Prepare providers for credentialing committee review
- Process provider terminations updates revalidations
- Provide customer service support for provider inquiries
- Support provider education on enrollment requirements
- Track application status follow up on delays or denials
- Track credential expiration dates initiate renewals
Perks/Benefits
- 401k
- Bonus
- Flexible work location
- Healthcare coverage
- Registered Dietitian Sessions
- Remote-first
- Unlimited PTO
Skills/Tech-stack
CAQH | CMS | Compliance | Credentialing | Data Management | Data entry | Enrollment | Healthcare regulations | Medicaid | Medical terminology | Medicare | NCQA | NPDB | NPPES) | OIG | PECOS | Primary Source Verification | SAM | Source verification
Education
N/A
Related jobs
-
Payer Enrollment Coord II USD 38K-54KCAQH | Credentialing | ETIN | Electronic submission | Healthcare reimbursementRemote workMid-level Full TimeRemote Work - New York, United … R7d ago
-
Admissions interview scheduling | Application Review | Data Management | Data Privacy | Data SecurityExecutive-level Full TimeNew York City (Cornell Tech), United … R8d ago
-
Data Governance Coordinator USD 44K-44KBills of Material | Costing | Data Governance | Data Integrity | Data Management401k match | Career Development Programs | Casual dress | Educational assistance program | Employee assistance programNone Full TimeOmaha NE Main Office, United States R11d ago
-
Customer Service | Data Analysis | Database Management | Email | HIPAARemote workMid-level Full TimeWestborough, MA, United States R22d ago
-
Compliance Management | Customer Service | Data Analysis | Database Management | EmailRemote workMid-level Full TimeWestborough, MA, United States R22d ago
-
CRM | Call scripting | Consultative selling | Customer Relationship Management | Customer relationship401k | Employee assistance program | Flexible spending account | Life insurance | Long-term disabilityEntry-level Full TimeWork@Home USA, United States R23d ago
-
AI Researcher & Implementation Coordinator PHP 420K-456KAPI Integration | Artificial Intelligence | Automation | CRM | Case managementHMO & Insurance | Internet allowance | Paid US Holidays | Paid sick leave | Paid vacationMid-level Full TimePhilippines - Remote R30d ago
-
Fulfillment & Logistics Coordinator USD 12K-14KAmazon Seller | Amazon Seller Central | ClickUp | Data Management | Data ManipulationFully remote | Global company experience | Paid Holidays | Paid time offMid-level Full TimePhilippines - Remote R1mo ago