Credentialing Liaison

CPS•Louisville, KY

14d

About The Position

The Credentialing Liaison is an administrative coordination role supporting provider and facility credentialing, enrollment, payer relations, contract administration, acquisition transitions, and ASC licensure activities. The liaison serves as the day-to-day contact for the outsourced credentialing partner and works with RCM leadership, ASC operations, payer representatives, Legal, and other internal and external partners. The role maintains accurate records, trackers, worklists, and status reports; verifies payer participation and effective dates; follows up on outstanding matters; and escalates delays, network gaps, deadlines, and reimbursement risks to the RCM Manager or appropriate leadership. The role supports enrollment and recredentialing activities in athenaOne, including maintaining worklist statuses and documentation, reconciling items against payer submissions and confirmations, and ensuring completion is supported by written payer confirmation. It also maintains payer agreement and participation inventories, coordinates payer notifications for acquisitions and transitions, and organizes ASC licensure, certification, enrollment, and contract documentation. This position has administrative coordination authority only. It does not independently negotiate reimbursement rates or contract terms, approve proposals, execute agreements, or make final contracting decisions; those responsibilities remain with designated CPS leadership.

Responsibilities

Serve as the primary day-to-day liaison to the outsourced credentialing partner and monitor enrollment, recredentialing, payer loading, and outstanding deliverables.
Collect and validate provider documentation, including licenses, DEA, malpractice, CAQH, board certification, and enrollment records.
Coordinate provider onboarding, location additions, transitions, roster reconciliation, and status reporting; escalate delays to the RCM Manager.
Monitor and maintain the athenaOne enrollment worklist, keeping provider and payer enrollment tasks, statuses, follow-up dates, and supporting notes current and accurate.
Reconcile athenaOne worklist items with submitted applications, payer acknowledgments, approvals, denials, and effective dates in coordination with the outsourced credentialing partner.
Enter or coordinate timely updates to provider enrollment records, payer participation information, and applicable provider or location details in athenaOne within assigned access and approval protocols.
Identify stalled, incomplete, duplicate, or inconsistent worklist items; obtain missing information, document follow-up, and escalate issues that may delay claims submission or reimbursement.
Validate enrollment completion and effective dates against written payer confirmation before marking worklist items complete, and communicate material changes to RCM and operational stakeholders.
Prepare routine athenaOne enrollment worklist aging, outstanding-item, and completion reports for the RCM Manager.
Verify provider, group, and facility network participation, effective dates, affiliations, payer products, and service locations.
Research payer enrollment and participation requirements and resolve discrepancies through documented payer follow-up.
Support payer projects, roster updates, demographic changes, and contracting implementation activities.
Maintain a centralized repository of professional, ancillary, laboratory, and ASC payer agreements, amendments, fee schedules, and related documents.
Request missing executed agreements, amendments, reimbursement exhibits, and supporting documentation from payer representatives.
Maintain contract inventories covering entities, TINs, NPIs, locations, effective dates, renewals, termination notice requirements, and applicable products or networks.
Track renewal, amendment, and notice deadlines; verify participation and contract loading; and identify discrepancies with payer rosters and internal records.
Support contract research, payer outreach, documentation gathering, and implementation tracking; maintain correspondence logs and escalate risks to the RCM Manager.
Coordinate payer notifications and documentation for acquired practices, providers, facilities, and business entities.
Maintain acquisition payer notification matrices documenting impacted payers, entities, requirements, deadlines, owners, submissions, acknowledgments, and status.
Research payer-specific requirements for asset and stock purchases, changes of ownership or control, TIN/NPI changes, and provider or facility transitions.
Prepare and distribute payer acquisition notifications after RCM leadership and, where appropriate, Legal approval.
Request current contracts, provider and location rosters, and written participation confirmations for acquired entities.
Coordinate with payer network management and the outsourced credentialing partner on transition requirements, amendments, enrollment, and roster updates.
Track payer responses and implementation milestones, obtain written confirmation of effective dates and outstanding actions, and provide regular transition status reports.
Escalate network gaps, delays, and reimbursement risks.
Provide administrative support for credentialing, enrollment, recredentialing, and payer contracting activities across CPS-affiliated ambulatory surgery centers.
Coordinate with the outsourced credentialing company, ASC operations, RCM leadership, and payer representatives to facilitate facility enrollment and network participation.
Gather and maintain ASC licenses, Medicare certifications, accreditation records, applicable CLIA certificates, NPIs, TINs, ownership records, and other payer-required documentation.
Assist with completion, submission, and tracking of ASC enrollment applications, demographic updates, facility additions, and recredentialing requests.
Request and organize executed ASC payer agreements, amendments, fee schedules, reimbursement exhibits, and related documentation.
Maintain an ASC contract and payer participation inventory documenting entities, facilities, networks, effective dates, renewal terms, and termination notice requirements.
Coordinate administrative follow-up with payer network management and contracting representatives regarding documentation, agreements, and implementation status.
Track ASC contracting projects, outstanding payer responses, facility loading, implementation milestones, and unresolved issues; obtain written payer confirmation when available.
Support acquisition-related ASC payer notifications, ownership updates, and facility transitions in coordination with RCM leadership and Legal.
Monitor licensure, accreditation, certification, and enrollment renewal dates; escalate impending deadlines and potential participation or reimbursement risks.
Provide timely status reporting and maintain accessible records of payer correspondence, submissions, and confirmations.
Maintain accurate electronic files, project trackers, action logs, and weekly status reports.
Support payer audits, practice expansions, operational transitions, and special projects assigned by RCM leadership.
Collaborate with RCM, clinical operations, finance, compliance, and external partners while protecting confidential information.
Provide timely follow-up and escalation of open credentialing items, accurate and documented participation and effective-date verification, current contract records and deadlines, tracked acquisition notifications, accurate payer transition trackers, current ASC licensure and certification records, weekly status updates, and prompt escalation of revenue risks.