Credentialing and Enrollment Coordinator

Description

About Us

Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.

Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.

Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike.

Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company.

Summary of Position

The Credentialing and Enrollment Coordinator is responsible for performing and maintaining the enrollment and credentialing process for health insurance plans, state Medicaid entities, and Medicare for all company-owned entities. Included in these activities are the processing of Commercial and Governmental applications and re-applications, initial mailing, review, and loading into the database tracking system ensuring timing and quality standards are maintained.  Additionally, the Credentialing and Enrollment Coordinator must have the ability to prioritize and organize complex activities/projects and track progress as well as work effectively and collaboratively with others. The ideal candidate will possess contract administration experience, including appropriate analytical skills, attention to detail, and will be able to work independently.

Key Job Elements

• Securing and maintaining all health insurance plan enrollment and re-enrollment for the Company
• Perform necessary follow-up with appropriate state and federal agencies
• Completing commercial plan facility credentialing and re-credentialing forms for the Director of Managed Care
• Securing Electronic Funds Transfer form with appropriate Company authorized signature
• Create and maintain web portal registration for executed contracts
• Manage the controlled flow of contract documents through the company to secure appropriate Legal review and Executive signatures
• Maintain Commercial Contract Summary Log
• Maintain government entity Tracking log
• Maintain department files in an organized, accurate, secure manner.
• Manage incoming and outgoing departmental mail.
• Process credentialing applications/enrollments and the supporting documentation.
  • Enroll entities in Medicare and revalidate information, as necessary.
  • Enroll entities in State Medicaid programs and revalidate information as necessary.
  • Complete commercial health plan credentialing and recredentialing documents for all entities.
  • Complete credentialing and recredentialing documentations for all entities which require physician credentialing.
• Track license and certification expirations to confirm renewals.
• Maintain accurate information for entities, updating their credentials as necessary.
• Perform data entry into databases or systems.
• Responsible for health plan/government entity provider-related communications pertaining to credentialing/enrollment.
• Respond to internal and external customer inquiries regarding credentialing/enrollment status.
• Perform other duties, as required, or assigned.

Qualifications

Knowledge/Experience

• High School diploma or equivalent
  • Bachelor degree preferred
  • 1 years of experience in healthcare contracting
  • Computer skills to include Word, Excel, Power Point, Outlook
  • Strong interpersonal and communication skills, both written and oral, with varying levels of colleagues and/or management
  • Ability to manage open projects to the end with successful follow up
  • Attention to detail and strong organization skills
  • Ability to work independently within guidelines and company policies
  • Ability to effectively present information and respond to questions from managers, clients, and customers

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term “qualified individual with a disability” means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.

For California residents, please see the link below to access our CCPA Privacy Notice.

CCPA Privacy Notice for California Residents

https://tinyurl.com/FulgentCCPA