Credentialing and Provider Enrollment Coordinator

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

📋 Description

• Manage the daily credentialing and re-credentialing processes for all providers.

• Verify that provider files from ACVS comply with managed care standards.

• Conduct state-specific credentialing verifications.

• Distribute newly credentialed provider rosters to delegated payers.

• Complete and submit CAQH applications to non-delegated payers.

• Execute roster runs for delegated audits and provide assistance with credentialing/enrollment audits.

• Handle updates, changes, and terminations of provider data in MD Staff.

• Submit monthly provider data updates to payers.

• Follow up with payers to ensure timely and accurate loading of new providers.

• Generate documentation that adheres to payer and NCQA standards.

• Remain informed on regulatory, legal, and legislative changes and communicate updates accordingly.

⛳️ Requirements

• High School diploma or equivalent, OR at least 1 year of relevant cumulative experience required.

• Professional licensure or certification may substitute for education or experience, if applicable.

• Preferred: 2 to 3 years of experience in delegated credentialing.

• Preferred: 2 to 3 years of experience within a health plan environment.

• Capability to perform state-specific credentialing verifications.

• Familiarity with managed care standards, payer requirements, and NCQA guidelines.

• Proficient in using CAQH, MD Staff, and payer roster systems.

• Ability to monitor and understand regulatory, legal, and legislative requirements.

🏝️ Benefits

• Comprehensive health coverage including medical, dental, vision, prescription coverage, and HSA/FSA options.

• 403(b) retirement plan with employer matching.

• Access to planning and hardship resources.

• Disability and life insurance options.

• Pro-rated paid time off (PTO) and holidays.

• Tuition assistance through Ascension (Vocare).

• Reimbursement opportunities.

• Continuous professional development and access to online learning resources.

• Employee Assistance Program.

• Counseling and peer support services.

• Resources for spiritual care and stress management.

• Parental leave benefits.

• Adoption assistance and family-related benefits.

• Optional legal and pet insurance.

• Transportation savings options.