Credentialing and Provider Enrollment Coordinator

Ascension•Remote,

2h•$41,040 - $55,531•Remote

About The Position

This role is responsible for completing day-to-day credentialing and re-credentialing for all providers, ensuring provider files meet managed care criteria. The coordinator will complete state-specific credentialing verifications, send credentialed rosters to delegated payers, and submit CAQH applications to non-delegated payers. They will also run rosters for delegated audits, assist in credentialing/enrollment audits, process provider data updates and changes in MD Staff, and follow up with payers to ensure timely and correct loading of new providers. Additionally, the role requires producing documentation to meet payer and NCQA guidelines, processing provider data updates, changes, and terms in MD Staff, and staying informed about regulatory, legal, and legislative issues, communicating any changes.

Requirements

High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
Required professional licensure/certification can be used in lieu of education or experience, if applicable.

Nice To Haves

2 or 3 years of delegated credentialing experience, strongly preferred.
2 or 3 years of health plan experience, strongly preferred.

Responsibilities

Complete the day to day credentialing/re-credentialing for all providers.
Ensure the provider file from ACVS meets managed care criteria.
Completes state specific credentialing verifications as necessary.
Send newly credentialed rosters to all delegated payers.
Complete and submit CAQH applications to all non delegated payers.
Run rosters for all delegated audits.
Assist in audits related to credentialing/enrollment.
Process provider data updates, changes and terms in MD Staff and submit to payers monthly.
Follow up with payers to ensure new providers are loaded timely and correctly.
Produce required documentation to meet payer and NCQA guidelines.
Process provider data updates, changes and terms in MD Staff.
Stays abreast of regulatory, legal and legislative issues and requirements and communicates changes.