Credentialing and Enrollment Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Confirm provider qualifications and oversee the enrollment process for groups and providers with both government and commercial insurance payers.

• Gather, validate, and maintain provider credentials, which include education, licensure, board certification, DEA registration, malpractice insurance, and work history.

• Perform primary source verification of licenses, certifications, and educational backgrounds through official channels.

• Assist in compliance initiatives with regulatory and accrediting authorities.

• Update and manage provider profiles in CAQH through the Group Profile.

• Monitor credential expiration dates and initiate the renewal process.

• Prepare providers for review by the credentialing committee and address requests for additional information.

• Conduct or review background checks, NPDB queries, and OIG/SAM exclusion list verifications.

• Ensure adherence to NCQA, CMS, or state-specific credentialing standards.

• Enroll providers with Medicare, Medicaid, and commercial insurance payers.

• Complete and submit applications for payer enrollment.

• Monitor application statuses and follow up with payers to address delays or denials.

• Associate providers with group practices and tax ID numbers relevant to appropriate payers.

• Manage provider terminations, updates, and re-validations with payers.

• Coordinate enrollment effective dates with billing and revenue cycle teams to prevent claim denials.

• Enter provider information into credentialing and enrollment databases and systems.

• Ensure data accuracy and maintain confidentiality.

• Produce basic credentialing and enrollment reports.

• Address inquiries from providers and payers, providing support for provider education on enrollment requirements.

• Collaborate with the Credentialing and Enrollment Team, Clinical Operations, and clinical staff to maintain professional practice and regulatory compliance.

⛳️ Requirements

• At least 1 year of experience in Medicare and/or Medicaid enrollment.

• Knowledge of CAQH, PECOS, NPPES, and state-specific enrollment portals.

• Understanding of medical terminology and healthcare/CMS regulations.

• Proficient in data entry and management software.

• Strong organizational and time management skills with a proven attention to detail.

• Ability to handle multiple complex projects and consistently meet deadlines.

• Exceptional written and verbal communication skills.

• Capability to work independently as well as collaboratively within a team setting.

• Commitment to safeguarding the confidentiality of sensitive information.

• Candidates must live in and work within the US.

🏝️ Benefits

• Remote-First Company.

• Unlimited PTO.

• Flexible & remote working location.

• Healthcare Coverage (Medical, Dental, Vision).

• 401k & bonus.

• Registered Dietitian Sessions.