Credentialing and Provider Enrollment Coordinator

About the role

Complete the day-to-day credentialing/re-credentialing for all providers. Ensure the provider file from ACVS meets managed care criteria. Completes state specific credentialing verifications as necessary. Sends newly credentialed rosters to all delegated payers. Completes and submits CAQH applications to all non-delegated payers. Runs rosters for all delegated audits. Assists in audits related to credentialing/enrollment. Processes provider data updates, changes and terms in MD Staff and submits to payers monthly. Follows up with payers to ensure new providers are loaded timely and correctly. Produces required documentation to meet payer and NCQA guidelines. Processes provider data updates, changes and terms in MD Staff. Stays abreast of regulatory, legal and legislative issues and requirements and communicates changes.

Responsibilities

• Completes day-to-day credentialing/re-credentialing for all providers
• Maintains provider files to meet managed care criteria
• Verifies state-specific credentials as needed
• Sends newly credentialed rosters to all delegated payers
• Submits CAQH applications to non-delegated payers
• Runs rosters for all delegated audits
• Assists in audits related to credentialing/enrollment
• Processes provider data updates, changes, and terms in MD Staff
• Submits provider data updates, changes, and terms to payers monthly
• Follows up with payers to ensure timely and correct loading of new providers
• Produces required documentation to meet payer and NCQA guidelines
• Processes provider data updates, changes, and terms in MD Staff
• Stays informed about regulatory, legal, and legislative issues and communicates changes

Requirements

• High school diploma equivalency or 1 year of applicable cumulative job-specific experience
• Required professional licensure/certification can be used in lieu of education or experience, if applicable

Preferences

• 2 or 3 years of delegated credentialing experience, strongly preferred
• 2 or 3 years of health plan experience, strongly preferred

Benefits

Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
Time to recharge: pro-rated paid time off (PTO) and holidays
Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
Family support: parental leave, adoption assistance and family benefits
Other benefits: optional legal and pet insurance, transportation savings and more