Provider Enrollment Coordinator

Job Summary

Responsible for the coordination and overall tracking of the credentialing process, including the review of specialists' work and providing guidance for complex or difficult cases.

Essential Functions

• Review and screen credentialing applications - Ensure all applications are complete, accurate, and meet federal, state, local, and internal standards.
• Confirm required documents are submitted and align with policy and regulatory expectations.
• Conduct primary source verification and resolve issues - Verify licenses, certifications, education, and training directly with original sources. Identify and resolve discrepancies, time gaps, or inconsistencies that could delay approval.
• Audit and monitor credentialing files - Review documentation for completeness and compliance with quality, accreditation, and organizational standards. Proactively track file status to prevent delays or missing information.
• Interpret regulatory requirements and reporting - Review reports, scoring, and requirements from accrediting and regulatory bodies. Ensure processes align with current compliance standards and guidelines.
• Provide oversight and support to credentialing staff - Guide specialists through complex cases and ensure adherence to policies. Support training, onboarding, and ongoing development of team members.
• Manage provider enrollment with payors - Oversee timely enrollment of new providers with commercial and government payors (e.g., Medicare, Medicaid). Ensure continued participation and revalidation for existing providers.
• Maintain provider data and system accuracy - Update and manage provider records in CAQH and internal systems. Process demographic updates, billing changes, and termination requests accurately and on time.
• Collaborate with credentialing teams, payors, hospitals, and practice groups to meet deadlines. Act as a liaison to resolve issues and streamline communication.
• Track performance, reporting, and compliance readiness - Produce regular enrollment and status reports to monitor progress. Support audits, ensure NCQA and payor compliance, and stay current on industry changes to recommend process improvements.

  Qualifications

  • Education: Associate's Degree in related field of study preferred. High School Diploma or Equivalent required.
  • Experience: Clinical/Medical Office/Healthcare Experience 2-3 years required. Credentialing/Accreditation Experience 2-3 years required.
  • Knowledge, Skills And Abilities: 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.

    Additional Job Details

    (if Applicable)

    Remote Type

    Remote Work Location: 399 Revolution Drive

    Scheduled Weekly Hours

    40

    Employee Type

    Regular

    Work Shift

    Day (United States of America)

    Pay Range

    $17.71 - $25.28/Hourly

    Grade

    2

    At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization.

    EEO Statement

    Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

    Mass General Brigham Competency Framework

    At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.