Provider Enrollment Coordinator

Mass General Brigham•Somerville, MA

1d•$20 - $28•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

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.

Nice To Haves

Associate's Degree Related Field of Study preferred

Responsibilities

Review and screen credentialing applications to ensure completeness, accuracy, and compliance with federal, state, local, and internal standards.
Confirm required documents are submitted and align with policy and regulatory expectations.
Conduct primary source verification of licenses, certifications, education, and training, and resolve any discrepancies, time gaps, or inconsistencies.
Audit and monitor credentialing files for completeness and compliance with quality, accreditation, and organizational standards, proactively tracking file status.
Interpret regulatory requirements and reporting from accrediting and regulatory bodies, ensuring processes align with current compliance standards.
Provide oversight and support to credentialing staff, guiding them through complex cases and ensuring adherence to policies.
Manage provider enrollment with payors, overseeing timely enrollment of new providers and continued participation/revalidation for existing providers.
Maintain provider data and system accuracy in CAQH and internal systems, processing demographic updates, billing changes, and termination requests.
Coordinate with credentialing teams, payors, hospitals, and practice groups to meet deadlines and resolve issues.
Track performance, reporting, and compliance readiness, producing regular reports and supporting audits.
Stay current on industry changes to recommend process improvements.