Credentialing Enrollment Coordinator

Description

POSITION SUMMARY: 

Preparing and submitting all provider credentialing and recredentialing applications and conducting necessary follow-up nationwide. 

  KEY RESPONSIBILITIES:  

• Participate in credentialing and re-credentialing activities. 
• Assist with payer enrollment applications and updating CAQH and NPPES and PECOS databases  
• Update Payer portals (e.g., Availity, NaviNet) 

• Initiate State License applications and process until issued 
• Assist with uploading therapist applications and entering new therapist data into Credentialing Software 
• Review all therapists’ applications for accuracy and verify that all supporting documents have been received 
• Access various sources (e.g., PT/OT schools, therapist practices) to obtain documents needed for credentialing. 
• Medicaid and Medicare application and re-validation. 

• Update and maintain current, accurate information related to provider data, demographics, insurers, and applicable information in the database. 
• Assist department in completing the credentialing and the recredentialing (e.g., follow-up for affiliations) 
• Produce credentialing and licensing queries and reports. 
• Submission of provider applications for enrollment in all commercial insurance, Medicaid Managed Care and government plans for multiple locations and states. Tracks and maintains enrollments through timely re-validations.  
• Works closely with the insurance enrollment departments to discern specific enrollment requirements including pre-requisites, forms, documentation, and timelines. Establishes relationships at the health plans necessary to promote swift enrollment turnaround time. Performs follow-up with insurance payors via phone, email, fax or website to resolve provider enrollment issues. Negotiates to overcome roadblocks. 

• Maintains accurate records of enrollment activities, including but not limited to, maintaining enrollment data, documenting activities through notes, tracking progress on enrollment worksheets, uploading enrollment related documentation and communications, for access by all team members, and to ensure business continuance. 
• Establishes providers’ CAQH (Council for Affordable Quality Healthcare) profiles. Maintains profiles up to date, uploading documents as required, and re-attesting profiles every 120 days. if applicable. 

Qualifications

MINIMUM JOB REQUIREMENTS: 

• 1 year of provider credentialing experience 
• 1 year of payor credentialing/provider enrollment experience preferred 
  CAQH, credentialing or other credentialing/enrollment data bases preferred 

• Pecos, NPPES and payer portal exp 
• Expertise with Adobe Acrobat Pro and Microsoft Office (Excel, Word, PowerPoint, Outlook) required 

Education / Training: 

0 – 2 Years 

Specialized Knowledge/Skills: 

 
Data Entry experience, required.  

Credentialing/Payor Relations, preferred.   
Excellent customer services skills 

Ability to work independently 

Strong organizational and multitasking skills 

Strong computer skills (Microsoft Office, Excel, Adobe, Power Point) 

Ability to function in a fast-paced environment