Credentialing and Provider Enrollment Coordinator

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

📋 Description

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

• Ensure that provider files from ACVS adhere to managed care standards.

• Perform state-specific credentialing verifications as needed.

• Distribute newly credentialed rosters to all delegated payers.

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

• Generate rosters for all delegated audits.

• Support audits related to credentialing and enrollment activities.

• Process updates, modifications, and terminations of provider data in MD Staff and submit these to payers on a monthly basis.

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

• Create necessary documentation to comply with payer and NCQA standards.

• Stay informed about regulatory, legal, and legislative changes and communicate these updates.

⛳️ Requirements

• High School diploma or equivalent, or 1 year of relevant cumulative job-specific experience is required.

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

• 2 to 3 years of experience in delegated credentialing is strongly preferred.

• 2 to 3 years of experience in a health plan setting is strongly preferred.

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

• Proficient in completing state-specific credentialing verifications.

• Capable of completing and submitting CAQH applications.

• Skilled in processing provider data within MD Staff.

• Able to conduct or assist with credentialing/enrollment audits.

• Competent in monitoring regulatory, legal, and legislative requirements.

🏝️ Benefits

• Paid time off (PTO).

• A variety of health insurance options and wellness plans.

• Retirement benefits, including employer matching plans.

• Long-term and short-term disability coverage.

• Employee assistance programs (EAP).

• Parental leave and adoption assistance.

• Tuition reimbursement opportunities.

• Opportunities to contribute to your community.