Credentialing and Payer Contracting Coordinator

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

📋 Description

• Oversee the initial credentialing, payer enrollment, and recredentialing processes for both new and existing clinicians.

• Gather, assess, and arrange provider documentation, which includes licenses, DEA registrations (if applicable), malpractice coverage, CVs, educational and employment history, board certifications, W-9s, NPIs, taxonomy codes, disclosures, and attestations.

• Ensure provider profiles are accurately maintained in CAQH ProView, NPPES, PECOS, state Medicaid systems, commercial payer portals, and internal tracking systems.

• Prepare, submit, and monitor enrollment applications, roster additions, demographic updates, service-location modifications, reassignment requests, terminations, and payer inquiries for additional information.

• Engage with payer representatives via phone, email, portals, and ticketing systems; document communications and escalate stalled or urgent applications as needed.

• Assist in the payer-contracting lifecycle, which includes network-interest submissions, contracting applications, agreement intake, fee-schedule organization, redline tracking, signature routing, amendments, and renewals.

• Direct reimbursement, legal, and operational terms to the appropriate internal stakeholders for review and approval.

• Maintain a trustworthy source of truth for each provider and payer, detailing application status, participating plans, contract status, effective dates, rates, renewal dates, outstanding items, owners, and next follow-up dates.

• Collaborate with provider operations, revenue cycle, finance, legal, and billing teams to ensure credentialing, contracting, roster loading, and billing setup are finalized before providers are marked as ready to bill.

• Monitor licenses, attestations, recredentialing deadlines, contract renewals, and other expirations.

• Investigate discrepancies across provider records, payer portals, contracts, directories, and internal systems, driving issues through to verified resolution.

• Track turnaround times, aging applications, deadlines, payer bottlenecks, and operational risks via weekly reporting.

• Identify recurring challenges and enhance workflows using templates, checklists, documentation, automation, and escalation processes.

• Safeguard provider and patient information by adhering to privacy, security, and access-control regulations.

⛳️ Requirements

• A minimum of 2 years of experience in provider credentialing, payer enrollment, contract administration, provider operations, medical-staff services, revenue-cycle operations, or a related field in healthcare administration.

• Proficient in both spoken and written English.

• Practical experience with CAQH ProView, NPPES, PECOS, Availity, state Medicaid systems, or commercial payer portals.

• Knowledge of initial credentialing, recredentialing, roster management, provider demographic updates, and payer effective-date verification.

• Experience in supporting payer contracting, fee-schedule evaluations, contract routing, amendments, or network-development workflows is highly preferred.

• Experience in behavioral health, telehealth, or multi-state provider-network environments is advantageous.

• CPCS or another credentialing certification is beneficial, but not mandatory.

• Exceptional attention to detail when recognizing inconsistencies in names, addresses, licenses, NPIs, TINs, taxonomy codes, and effective dates.

• Ability to manage numerous applications, contracts, deadlines, and payer discussions simultaneously.

• Persistent and professional follow-up with payers to resolve delayed or incomplete applications.

• Capability to identify risks and escalate issues proactively.

• Adaptability to new payer requirements, systems, and evolving processes.

• Skill in maintaining clear documentation with an owner, status, next step, and follow-up date for every open item.

• Trustworthiness with sensitive information and a disciplined approach to authorization, attestations, signatures, and access controls.

• Availability to work from 8:00 AM to 5:30 PM Central Time.

🏝️ Benefits

• Fully remote work setup