Credentialing and Provider Enrollment Coordinator
About The Position
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.
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.
Benefits
- Paid time off (PTO)
- Various health insurance options & wellness plans
- Retirement benefits including employer match plans
- Long-term & short-term disability
- Employee assistance programs (EAP)
- Parental leave & adoption assistance
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
