Credentialing, Privileging & Enrollment Coord

We are seeking an experienced Credentialing, Privileging, and Enrollment Coordinator to join our organization.

In this role, you will oversee the credentialing, privileging, re-credentialing, and enrollment processes for medical and behavioral staff throughout their employment lifecycle. Your work will ensure client safety, maintain high-quality care, and facilitate compliance with regulatory standards. You will also be responsible for maintaining up-to-date provider data and ensuring licensed staff are enrolled with affiliated medical insurance payers to support organizational billing.

Key Responsibilities

Credentialing and Privileging

• Conduct comprehensive initial and ongoing credentialing and privileging of healthcare providers, ensuring compliance with industry standards and regulatory requirements.
• Maintain thorough and organized electronic credentialing and privileging files, including licenses, certifications, and training documentation.
• Obtain and document primary and secondary source verifications as required.
• Produce and distribute status reports and summaries regularly and upon request.

Provider Enrollment

• Coordinate provider enrollment with Medicare, Medicaid, and commercial payers.
• Collaborate with the Revenue Cycle Team to ensure payer rosters are current with contracted providers.
• Maintain accurate tracking logs for Managed Care Organizations, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH databases.

Compliance and Auditing

• Track license and certification expirations, ensuring timely renewals for all providers.
• Proactively engage with providers and departments to solicit, validate, and store documentation.
• Create and maintain Standard Operating Procedures (SOPs) to ensure consistency and compliance in credentialing, privileging, and enrollment processes.
• Participate in regular audits and site or regulatory visits, providing documentation as required.

General Agency Responsibilities

• Model and reinforce the organization’s core values: dignity, authenticity, hope, justice, passion, and balance.
• Actively participate in performance improvement and advocacy activities supporting the organizational mission.
• Maintain compliance with HIPAA and other relevant healthcare IT security regulations.

Qualifications

Education and Certifications

• Associate’s degree required; Bachelor’s degree preferred, ideally in HR, business, or a related field.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.

Experience

• At least three years of administrative experience in a healthcare setting, with a minimum of two years in credentialing, privileging, and/or enrollment.
• Experience in a primarily digital administrative environment, preferred.
• Knowledge of credentialing and privileging requirements of government and accreditation bodies (HRSA, NCQA, The Joint Commission) is a plus.

Skills

• Strong process-oriented mindset with attention to detail and accuracy.
• Intermediate proficiency with Microsoft Office and HRIS or similar systems.
• Ability to independently problem-solve and work effectively under tight deadlines.
• Excellent organizational skills, with the ability to manage multiple priorities.
• Demonstrated cultural sensitivity and commitment to fostering an anti-racist workplace.
• Ability to build relationships across all levels of the organization while maintaining confidentiality and discretion.

Why Join Us?

• Be part of a mission-driven organization that prioritizes dignity, equity, and high-quality care.
• Opportunity to make a significant impact by supporting the organization’s ability to deliver essential services.
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Health Care for the Homeless is an Equal Opportunity Employer Health Care for the Homeless is an equal opportunity employer and is committed to racial equity and inclusion. We make a particular effort to recruit and promote Black, Indigenous and People of Color (BIPOC) for open positions. BIPOC, LGBTQIA individuals, people with disabilities, and people with other marginalized identities are encouraged to apply.