Provider Enrollment Coordinator

Crossroads Treatment Centers•Greenville, SC

About The Position

Crossroads Treatment Centers is seeking a Provider Enrollment Coordinator to join their team. This role is crucial in ensuring that healthcare providers are properly enrolled and credentialed with various payors, facilitating accessible and high-quality treatment for patients with opioid use disorder. The company is dedicated to combating the opioid epidemic through evidence-based medication-assisted treatment (MAT) and has a growing network of outpatient clinics across the U.S.

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.

Nice To Haves

Experience with Modio software

Responsibilities

Receives notifications from the Clinician Onboarding Liaison (COL).
Works closely with the recruiting team during the onboarding process of new providers and provides weekly credentialing updates on payor enrollment status.
Obtains and maintains provider credentialing documents for new and existing providers, including expiring documentation.
Provides timely and pertinent information on providers for Credentialing Committee review and approval.
Escalates Provider Credentialing issues to the Director, as needed.
Escalates payor issues to Director, as needed.
Tracks, generates, and prepares applications to send to providers.
Conducts payer research on the provider.
Adds providers to the Credentialing report.
Reviews returned packets for accuracy and communicates updates to the Providers.
Reviews weekly exception reports from management to prioritize critical issues.
Follows up with providers for un-returned paperwork.
Sends updated credentials to the payer and completes payer credentialing applications for new facility locations in multiple states.
Researches state requirements prior to entry into the state and creates SOP regarding same.
Works with the Director and other key stakeholders on all new facilities, including enrollment of facilities and individual locations into new markets.
Keeps all key stakeholders informed of any challenges faced in new markets.
Serves as the primary point of contact for the withdrawal of a provider's employment; receives, updates, and notifies others, if needed.
Generates correct payer paperwork for re-validations/begins re-credentialing process.
Partners with COL, credentialing coordinators, and other key stakeholders in onboarding and enrolling providers and facilities with Medicaid, Medicare, commercial, and managed care plans.
Maintains provider enrollment processes and credentialing databases/websites/portals including CAQH, NPPES, Navinet, Availity, PECOS.
Supports the overall Provider Enrollment Department, assists the contracting department with requests as necessary, and works with RCM to assist with payer issues related to credentialing.
Meets at least monthly with health plans (more if needed) to obtain statuses of providers and to address any claims issues including holds and denials.
Works with payors to ensure timely enrollment & active status.
Escalates trends and issues to RCM, operations, and other key stakeholders as needed.