Credentialing and Enrollment Coordinator

This is a fully remote position, open to applicants in Mexico, +2 more countries.

📋 Description

• Manage the complete credentialing, re-credentialing, and payer enrollment process for licensed healthcare providers.

• Eliminate the backlog of expired provider applications to ensure proper billing.

• Execute enrollment, revalidation, and maintenance tasks in systems such as PECOS, NPPES, CAQH ProView, OPRA/eMedNY, OMH, and OASAS.

• Keep provider files and licensure records updated to demonstrate provider validity at the time of service.

• Conduct primary source verification for state licenses, DEA certificates, malpractice insurance, and educational backgrounds.

• Collaborate directly with clinicians to gather necessary documentation and sustain active licenses.

• Work alongside HR, Talent Acquisition, and Program Directors to credential new hires during the onboarding process.

• Examine and audit claim rejections related to enrollment in partnership with the billing team.

• Correct inaccuracies in clearinghouses and state payer registries.

• Maintain credentialing databases and create Tableau dashboards to present information on pipeline status, expiration timelines, and application aging.

• Utilize Claude and Microsoft Copilot for summarizing regulations, drafting compliance communications, and automating administrative tasks.

• Undertake additional projects as assigned by the Senior Director.

⛳️ Requirements

• Extensive end-to-end credentialing and enrollment expertise in the US healthcare system, with 3–5 years of relevant experience.

• Proficiency in English at a C1/C2 level; B2 may be considered for an otherwise outstanding candidate.

• Practical experience with PECOS, NPPES, CAQH ProView, and Medicare and Medicaid enrollment processes.

• Certification in CPCS or CPMSM.

• Strong familiarity with the New York State landscape, including OPRA/eMedNY, OMH, OASAS, and NYSED, is a notable advantage.

• Experience in creating Tableau dashboards and using generative AI tools like Claude and Microsoft Copilot; a willingness to engage with these tools is essential.

• Capability to independently manage the credentialing desk and address questions proactively.

• Persistence in following up with clinicians to secure necessary documentation.

• Quick adaptability to a new regulatory environment and a readiness to take on responsibilities beyond the standard job description.

🏝️ Benefits

• Fully remote work arrangement.

• Opportunity to make a meaningful impact within a mission-driven nonprofit.

• Chance to collaborate with pre-vetted LATAM professionals and engage in international healthcare operations.

• Access to generative AI tools, including Claude and Microsoft Copilot.