Credentialing & Enrollment Coordinator

Responsibilities

• Processes and submits complete, timely, and accurate applications and rosters to the appropriate constituents directly.
• Interprets and assists in implementing the standards of the National Committee for Quality Assurance (NCQA).
• Maintains and audits credentialing software and data integrity, updating the database accordingly.
• Processes requests and prepares correspondence to health plans through monthly communications.
• Serves as the first contact when communicating with practices and health plans regarding enrollment issues and directory listings.
• Performs health plan quarterly, semi-annual, and annual audits.
• Maintains current licensure, certifications, malpractice insurance, and other applicable regulatory items at the time of appointment and ensures continuous maintenance to uphold timeliness, accuracy, and integrity of the credentialing database system and compliance with regulatory agencies.

Requirements

• High School Diploma or GED required; Bachelor's Degree preferred.
• Certification by National Association Medical Staff Services or Certified Provider Credentialing Specialists preferred.
• Previous experience as a Credentialing Coordinator or Provider Enrollment preferred.
• Knowledge of NCQA standards and guidelines.

Skills

• Tech-savvy and self-starter.
• Detail-oriented with solid critical thinking skills.

Physical Requirements

Performs most work under normal office conditions. Work may require sitting for long periods of time, standing, walking, using repetitive wrist/arm motion frequently, and lifting.