Practitioner Mgmt Coord (US)

About the role

The Credentialing & Enrollment Specialist coordinates and maintains provider credentialing and enrollment activities to ensure compliance with organizational, regulatory, and health plan requirements. This role manages initial credentialing and recredentialing inventories, supports provider enrollment processes, conducts outreach for missing documentation, communicates credentialing decisions, and serves as a liaison between providers, network partners, and internal stakeholders.

Responsibilities

• Manage and maintain assigned initial credentialing and recredentialing inventories to ensure timely completion and compliance with established turnaround times.
• Review credentialing and enrollment applications for completeness and accuracy.
• Conduct outreach to providers, provider groups, and internal stakeholders to obtain missing or required documentation.
• Track and monitor credentialing and enrollment status through various systems and reports.
• Communicate credentialing approvals, denials, and status updates to providers and internal business partners.
• Support provider enrollment activities with government and commercial payers.
• Maintain accurate provider records, files, and databases.
• Monitor shared departmental email inboxes and respond to inquiries in a timely and professional manner.
• Collaborate with network partners, health plans, provider offices, delegated entities, and internal departments to resolve credentialing and enrollment issues.
• Prepare and maintain Excel spreadsheets, tracking logs, and reports for operational and audit purposes.
• Ensure compliance with NCQA, CMS, state regulatory, and organizational credentialing requirements.
• Assist with credentialing audits, data validation, and special projects as assigned.
• Escalate complex issues and aging inventory items as appropriate.

Requirements

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• Minimum of 2 years of healthcare credentialing and/or provider enrollment experience.
• Experience working with health plans, provider groups, or managed care organizations preferred.
• Knowledge of provider credentialing, recredentialing, and enrollment processes.

Skills

• Strong proficiency in Microsoft Excel, including sorting, filtering, reporting, and data management.
• Excellent verbal and written communication skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Experience maintaining shared mailboxes and managing high-volume communications.
• Ability to work independently and collaboratively with cross-functional teams.
• Customer service oriented with strong problem-solving skills.
• Knowledge of credentialing regulations, accreditation standards, and provider data management preferred.

Preferred Experience

• Experience with NCQA credentialing standards.
• Experience with provider enrollment systems, CAQH, PECOS, NPPES, Availity, and state Medicaid enrollment portals.
• Experience supporting delegated credentialing or managed care network operations.

Pay

The anticipated base salary range for this position is $24.20 to $43.56 per hour. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.