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
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