Credentialing and Enrollment Coordinator

Foodsmart

1d•$60,000 - $70,000•Remote

About The Position

The Credentialing and Enrollment Coordinator supports the healthcare provider compliance process by verifying provider qualifications and managing the enrollment of groups and providers with government and commercial insurance payers. This role ensures providers are properly credentialed and enrolled in a timely, accurate, and compliant manner, minimizing delays in providers' ability to see patients and bill for services. The ideal candidate is highly detail-oriented, organized, has a deep understanding of Medicaid and Medicare group and provider enrollment processes, and comfortable navigating multiple credentialing and payer systems while communicating and collaborating professionally with providers, team members, and payer representatives. The Credentialing and Enrollment Coordinator will work closely with the Credentialing and Enrollment Team, Clinical Operations department, and clinical staff to uphold the standards of professional practice and regulatory compliance such as CMS, NCQA, PECOS, with a primary focus on supporting the credentialing and enrollment of registered dietitians and other healthcare providers. This position offers an opportunity to gain a higher level of experience in healthcare administration while supporting the credentialing and enrollment processes. The ideal candidate will be detail-oriented, eager to learn, and possess strong organizational skills to assist in maintaining the quality of healthcare services. Candidates must reside in and work within the US.

Requirements

Minimum of 1 year of experience in Medicare and/or Medicaid enrollment, with foundational knowledge of related processes
Familiarity with CAQH, PECOS, NPPES, and state-specific enrollment portals
Working knowledge of medical terminology and healthcare/CMS regulations
Proficiency in data entry and management software
Strong organizational and time management skills, with demonstrated attention to detail
Proven ability to manage multiple complex projects and consistently meet deadlines
Excellent written and verbal communication skills
Ability to work both independently and collaboratively within a team environment
Commitment to maintaining confidentiality of sensitive information

Responsibilities

Collect, verify, and maintain provider credentials, including education, licensure, board certification, DEA registration, malpractice insurance, and work history
Conduct primary source verification (PSV) of licenses, certifications, and education through official sources
Support compliance efforts with regulatory and accrediting institutions
Maintain and update provider profiles in CAQH (Council for Affordable Quality Healthcare) through the Group Profile
Track credential expiration dates and proactively initiate renewals for licenses, CDRs, DEA registrations, board certifications, and malpractice coverage, as applicable
Prepare providers for credentialing committee review and respond to requests for additional information
Conduct/review background checks, National Practitioner Data Bank (NPDB) queries, and OIG/SAM exclusion list checks, etc.
Maintain compliance with NCQA, CMS, or state-specific credentialing standards
Help manage communication with providers, insurances, and related entities
Enroll providers with Medicare, Medicaid, and commercial insurance payers
Complete and submit payer enrollment applications
Track application status and follow up with payers to resolve delays or denials
Link providers to group practices and tax ID numbers with appropriate payers
Process provider terminations, updates, and re-validations with payers
Coordinate effective dates of enrollment with billing and revenue cycle teams to avoid claim denials
Support the interpretation of basic policies and procedures
Input provider information into credentialing/enrollment databases and systems
Maintain data accuracy and confidentiality
Assist in generating basic reports related to credentialing and enrollment
Help manage communication with providers, insurances, and related entities
Provide customer service support and help respond to inquiries
Support provider education efforts on enrollment requirements