Credentialing Specialist

Matrix Medical Management is looking for a Provider Enrollment (Credentialing) Coordinator to join our team!

The Provider Enrollment (Credentialing) Coordinator is responsible for the enrollment of providers with various payers for professional services reimbursement. The Provider Enrollment (Credentialing) Coordinator reviews provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements. Obtaining information from professional providers and other sources.

ESSENTIAL FUNCTIONS:

Onboarding

• Issue contracts to providers based on their statuses (1099, W2, locum) and monitor their status for timely completion

• Collaborate with Human Resources to ensure provider inquiries are resolved in a timely and effective manner

• Conduct provider onboarding and orientation to the practice

• Communicate updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.

• Support new provider onboarding processes as related to enrollment.

Credentialing

• Coordinate credentialing data needed for enrollment. Credentialing data includes but is not limited to the Medical Degree, Drug Enforcement Administration (DEA) number, and state license number, Board certifications, Curriculum Vitae (CV), and liability insurance.

• Complete provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner.

• Completing timely application processes based on payer specific formats

• Resolve enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified.

• Explain and inform providers and practice/office managers of the submission requirements for credentialing and recredentialing processes.

• Ensure the importance of compliance with credentialing/recredentialing processes is expressed

• Update on-site practice management and staff and of any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes

• Communicate any changes regarding contracting as it relates to enrollment and operations proactively

Administrative

• Manage surgery assignments schedules and distribution

• Manage contracts with providers and coordinate onboarding with HAA and PMR

• Ensures providers remain compliant with state federal regulations and company policies and procedures

• Maintain updated provider credentialing data, acting prior to expiration, completing all additions, updates, and deletions

• Obtain updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.

• Follow up continuously on enrollment and/or recredentialing statuses until complete

• Resolve issues as they are identified in a timely manner with primary source verification elements by interpreting, analyzing, and researching data

• Implement the entire enrollment process for all providers successfully, adhering to all timelines while maintaining strict confidentiality for matters pertaining to provider credentials

• Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions

• Maintains systems/applications used in the enrollment processes

• Develop databases and spreadsheets for tracking the organizations providers.

• Ensures data is accessible and transparent for executive inquiries or other information as deemed necessary by management

• Continuously searches for process improvements to achieve accuracy and efficiencies.

• Performs other duties as assigned or required.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Knowledge and understanding of credentialing process

• Ability to organize and prioritize work and manage multiple priorities

• Excellent verbal and written communication skills including letters, memos, and emails

• Excellent attention to detail

• Ability to research and analyze data

• Ability to work independently with minimal supervision

• Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization

• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

• Maintain positive working relationships with providers

• Experience with professional provider credentialing software (PECOS, NPPES, CMS, etc.)

EDUCATION AND EXPERIENCE:

• Associate Degree or 2 years of experience in lieu of education

• One (1) year of provider enrollment/credentialing experience

Matrix Medical Management is a healthcare management company headquartered in Northwest Houston, Texas. At Matrix Medical Management, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence. Come join our team at Matrix Medical Management where passion and career meet.

Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.

Employment for this position is contingent upon the successful completion of a background check and drug screening.