Provider Enrollment Coordinator

Mass General Brigham•Somerville, MA

4d•$18 - $25•Remote

About The Position

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Requirements

Associate's Degree Related Field of Study preferred
High School Diploma or Equivalent General Studies required
Clinical/Medical Office/Healthcare Experience 2-3 years required
Credentialing/Accreditation Experience 2-3 years required
Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
Knowledgeable in clinical and/or hospital operations and procedures.
Ability to use independent judgment and to manage and impart confidential information.
Skill in establishing priorities with independent coordination of day-to-day aspects.
Ability to communicate effectively both orally and in writing.
Strong organizational and project management skills.

Responsibilities

Review and screen credentialing applications to ensure all applications are complete, accurate, and meet federal, state, local, and internal standards.
Confirm required documents are submitted and align with policy and regulatory expectations.
Conduct primary source verification and resolve issues by verifying licenses, certifications, education, and training directly with original sources, and identifying and resolving discrepancies, time gaps, or inconsistencies that could delay approval.
Audit and monitor credentialing files by reviewing documentation for completeness and compliance with quality, accreditation, and organizational standards, and proactively tracking file status to prevent delays or missing information.
Interpret regulatory requirements and reporting by reviewing reports, scoring, and requirements from accrediting and regulatory bodies, and ensuring processes align with current compliance standards and guidelines.
Provide oversight and support to credentialing staff by guiding specialists through complex cases and ensuring adherence to policies, and supporting training, onboarding, and ongoing development of team members.
Manage provider enrollment with payors by overseeing timely enrollment of new providers with commercial and government payors (e.g., Medicare, Medicaid), and ensuring continued participation and revalidation for existing providers.
Maintain provider data and system accuracy by updating and managing provider records in CAQH and internal systems, and processing demographic updates, billing changes, and termination requests accurately and on time.
Coordinate across teams and external partners by collaborating with credentialing teams, payors, hospitals, and practice groups to meet deadlines, and acting as a liaison to resolve issues and streamline communication.
Track performance, reporting, and compliance readiness by producing regular enrollment and status reports to monitor progress, supporting audits, ensuring NCQA and payor compliance, and staying current on industry changes to recommend process improvements.