Credentialing and Provider Enrollment Coordinator

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

📋 Description

• Manage the credentialing process for practice providers and the enrollment process for insurance payers.

• Ensure prompt communication with practices and implementation teams to collect necessary credentialing and enrollment information.

• Handle initial and re-credentialing applications while performing primary source verification (CAQH, NPPES, etc.).

• Credential, link, and revalidate providers and groups with commercial and government payers.

• Keep up-to-date with payer credentialing policies, forms, and compliance standards.

• Identify and resolve enrollment issues, including claim denials and unbilled concerns.

• Maintain accurate provider participation (PAR) lists and share updates with stakeholders.

• Input provider demographics and credentialing information into credentialing software.

• Complete and monitor clearinghouse applications for EDI and ERA, and process EFT authorizations for payments.

• Collaborate with internal teams to create and refine enrollment policies and procedures.

• Promote continuous improvement and engage in special projects as necessary.

⛳️ Requirements

• An Associate or Bachelor’s degree in Healthcare Administration or a related field is preferred.

• CPCS (Certified Provider Credentialing Specialist) certification is preferred.

• A minimum of 3+ years of experience in healthcare payer enrollment and provider credentialing within a multi-specialty medical group.

• Experience collaborating with government agencies such as CMS and AHCA is strongly preferred.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and growth.

• Supportive and collaborative work environment.