Provider Enrollment/Credentialing Coordinator

Jackson Hospital•Montgomery, AL

About The Position

The Provider Enrollment Credentialing Coordinator is responsible for the enrollment of healthcare providers with health plans to minimize the possibility of delay or non-payment of claims rendered by practitioners. Collect and maintain providers' credentials and supporting documentation for the purpose of enrolling individual providers with payers. Complete Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new providers. Update, monitor, and maintain CAQH for existing providers. Responsible for completing applications, re-credentialing applications, demographic updates and documents to each payer for processing. Research payers for information on processes to enroll providers. · Monitor and follow up on the status of applications for providers and track progress on all pending and completed application. Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released. Participate in the physician onboarding process supporting credentialing and enrollment application process. Research and resolve provider related enrollment issues and coordinate with colleagues when necessary. Maintain provider files for revalidation of Medicaid and Medicare enrollments. Ensure the timeliness of provider enrollments. Other Duties as assigned.

Requirements

Associates degree required, prefer a Bachelor’s degree plus previous hospital business office experience
Excellent verbal and written communication skills
Exceptional organizational skills
Strong attention to detail
Ability to make independent decisions
Previous experience with files or data gathering
Ability to prioritize and organize multiple tasks
Meet established production and quality goals
Communicate and work well in a team environment
Ability to learn new software programs quickly

Responsibilities

Enroll healthcare providers with health plans
Collect and maintain providers' credentials and supporting documentation
Complete Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new providers
Update, monitor, and maintain CAQH for existing providers
Complete applications, re-credentialing applications, demographic updates and documents to each payer for processing
Research payers for information on processes to enroll providers
Monitor and follow up on the status of applications for providers and track progress on all pending and completed application
Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released
Participate in the physician onboarding process supporting credentialing and enrollment application process
Research and resolve provider related enrollment issues and coordinate with colleagues when necessary
Maintain provider files for revalidation of Medicaid and Medicare enrollments
Ensure the timeliness of provider enrollments
Other Duties as assigned