Provider Enrollment/Credentialing Coordinator

The Provider Enrollment Credentialing Coordinator is responsible for the enrollment of healthcare providers with health plans to minimize the possibility of delay or non-payment of claims rendered by practitioners. Collect and maintain providers' credentials and supporting documentation for the purpose of enrolling individual providers with payers. Complete Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new providers. Update, monitor, and maintain CAQH for existing providers. Responsible for completing applications, re-credentialing applications, demographic updates and documents to each payer for processing. Research payers for information on processes to enroll providers.

· Monitor and follow up on the status of applications for providers and track progress on all pending and completed application. Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released. Participate in the physician onboarding process supporting credentialing and enrollment application process. Research and resolve provider related enrollment issues and coordinate with colleagues when necessary. Maintain provider files for revalidation of Medicaid and Medicare enrollments. Ensure the timeliness of provider enrollments. Other Duties as assigned.

Qualifications

Associates degree required, prefer a Bachelor’s degree plus previous hospital business office experience Excellent verbal and written communication skills. Exceptional organizational skills. Strong attention to detail. Ability to make independent decisions. Previous experience with files or data gathering. Ability to prioritize and organize multiple tasks Meet established production and quality goals. Communicate and work well in a team environment. Ability to learn new software programs quickly.