Credentialing Coordinator, FT, Days

This is a fully remote position, open to applicants in Alabama, +27 more states.

📋 Description

• Oversee the comprehensive credentialing, re-credentialing, and payer enrollment process for behavioral health providers, their support staff, and associated facilities.

• Manage the onboarding process for new providers from the HR/Talent Acquisition notification through to the completion of their Medallion profile.

• Input and maintain essential provider information, including NPI, licensure, practice locations, and payer details.

• Request necessary documentation such as CAQH, PECOS, state licenses, DEA registrations, board certifications, diplomas, and other credentials; track their completion.

• Engage with physicians and providers via phone, text, and email to clarify requirements, resolve outstanding issues, and address inquiries.

• Conduct research and interpret state licensing, supervision, collaborative agreements, and scope-of-practice regulations.

• Execute primary source verifications, including NPI, NPDB, Medicare/Medicaid opt-out, state licensure, DEA, OIG, and SAM checks.

• Escalate any adverse findings through the credentialing committee review process.

• Coordinate the addition of malpractice policies and upload relevant insurance documentation to the credentialing platform and CAQH.

• Manage applications for commercial and government payer enrollment, including effective dates, payer IDs, and recredentialing timelines.

• Maintain and re-attest provider CAQH profiles.

• Assist with cross-state licensure and payer enrollment for telehealth providers.

• Facilitate state and program-specific registrations, Medicaid portal enrollment, domain transfers, surrogacy requests, and Medicare enrollment through CMS/PECOS.

• Oversee NPI acquisition and state Medicaid enrollment for behavioral health support staff; distribute compliance reports.

• Manage facility-level enrollment and maintenance within state Medicaid systems.

• Process terminations for providers and BHS staff, notifying relevant payers.

• Monitor OIG/SAM and NPDB databases, license renewals, board certifications, and recredentialing cycles.

• Complete credentialing documentation in accordance with delegated credentialing requirements.

• Collaborate with HR, Talent Acquisition, Medical Leadership, and operational leadership.

• Participate in quarterly Credentialing Committee meetings and prepare regular status reports.

• Support standardized credentialing workflows, reference guides, process documentation, and SOPs.

• Perform additional duties and responsibilities as assigned.

⛳️ Requirements

• A high school diploma or equivalent is required.

• A minimum of 2 years of experience in provider and/or facility credentialing, payer enrollment, or related managed care administrative roles.

• General understanding of regulatory requirements pertaining to credentialing and payer enrollment, including Medicare, Medicaid, and managed care processes and regulations.

• Ability to research and interpret state licensing board requirements for MD, DO, NP, and PA provider types.

• Experience with credentialing software platforms such as Medallion or similar credentialing management systems.

• Proficient knowledge of PECOS, CAQH, and state Medicaid provider portals.

• Strong customer service skills and interpersonal abilities, comfortable communicating with physicians and providers via phone, text, and email.

• Advanced proficiency in Microsoft Office products, especially Excel.

• Must be fully vaccinated with documentation or exempt through the company's exemption process prior to the start date.

• Preferred: Bachelor's degree in health care administration or a related field.

• Preferred: More than 3 years of credentialing or payer enrollment experience within a behavioral health setting.

• Preferred: Familiarity with CAQH attestation processes and delegated credentialing standards.

• Preferred: Experience in supporting multi-market or multi-state credentialing and enrollment operations.

🏝️ Benefits

• Employees (and their families) receive comprehensive health insurance, encompassing Medical, Dental, Vision, Accident, Critical Illness, and Hospital Indemnity coverage.

• CHS covers Basic Life, AD&D, Short and Long-Term Disability insurance.

• Voluntary Life insurance options are available for employees and their families.

• Health Savings Accounts with employer contributions ranging from $1,000 to $2,000 based on the selected plan.

• Flexible Spending Accounts for health care and dependent care expenses.

• 401k company match after 6 months (50% of deferrals up to 6% of compensation).

• Generous PTO policy starting at 160 hours accrued annually.

• 12 recognized company holidays.

• Company-paid parental leave is available for eligible employees.

• Employee Assistance Program offering confidential emotional support, work-life solutions, financial guidance, legal assistance, and online resources.

• After 90 days, automatic enrollment in the 401k Plan.