Provider Enrollment Coordinator - Remote

Crossroads Treatment Centers•Greenville, SC

3d•Remote

About The Position

Crossroads Treatment Centers is an equal opportunity employer committed to diversity and inclusion. Since 2005, Crossroads has been a leader in treating opioid use disorder through evidence-based medication-assisted treatment (MAT). We aim to provide accessible, high-quality care to combat the opioid epidemic and support patient recovery. Our outpatient, office-based clinics serve over 26,500 patients across multiple states. This role is remote and involves coordinating the enrollment and credentialing of healthcare providers with various payors.

Requirements

Minimum of 2 years of successful work experience in physician credentialing and/or physician enrollment.
Experience with provider credentialing databases/websites/portals (i.e.- CAQH, NPPES and PECOS).
Experience with Modio software preferred.
Working knowledge of the revenue cycle process.

Responsibilities

Receive notifications from the Clinician Onboarding Liaison (COL).
Work closely with the recruiting team during the onboarding process of new providers and provide weekly credentialing updates on payor enrollment status.
Obtain and maintain provider credentialing documents for new and existing providers, including managing expiring documentation.
Provide timely and pertinent information on providers for Credentialing Committee review and approval.
Escalate Provider Credentialing and payor issues to the Director as needed.
Track, generate, and prepare applications for providers.
Conduct payer research on providers.
Add providers to the Credentialing report.
Review returned packets for accuracy and communicate updates to providers.
Review weekly exception reports from management to prioritize critical issues.
Follow up with providers for un-returned paperwork.
Send updated credentials to the payer and complete payer credentialing applications for new facility locations in multiple states.
Research state requirements prior to entry into the state and create SOPs accordingly.
Work with the Director and other key stakeholders on all new facilities, including enrollment of facilities and individual locations into new markets.
Keep all key stakeholders informed of any challenges faced in new markets.
Serve as the primary point of contact for provider withdrawal of employment; receive, update, and notify others as needed.
Generate correct payer paperwork for re-validations and initiate the re-credentialing process.
Partner with COL, credentialing coordinators, and other key stakeholders in onboarding and enrolling providers and facilities with Medicaid, Medicare, commercial, and managed care plans.
Maintain provider enrollment processes and credentialing databases/websites/portals including CAQH, NPPES, Navinet, Availity, PECOS.
Support the overall Provider Enrollment Department, assist the contracting department with requests as necessary, and work with RCM to assist with payer issues related to credentialing.
Meet at least monthly with health plans (more if needed) to obtain provider statuses and address any claims issues, including holds and denials.
Work with payors to ensure timely enrollment and active status.
Escalate trends and issues to RCM, operations, and other key stakeholders as needed.