Provider Enrollment & Credentialing Coordinator

Responsibilities

• Coordinate initial credentialing and recredentialing for physicians, physician assistants, and advanced practice providers across Medicare, Medicaid, commercial insurers, and delegated payers.
• Obtain and maintain NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites.
• Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications.
• Track and maintain provider insurance participation status and effective dates in Athena.
• Maintain timely and accurate data entry in credentialing databases and payer portals; update provider rosters and profiles as needed.
• Process facility privilege applications and reappointments of privileges.
• Monitor and manage expirable documents (licenses, DEA, board certifications, malpractice insurance), alerting providers and escalating unresolved expirations to the Manager.
• Submit and update provider information in the CAQH ProView system as required by participating health plans.
• Ensure compliance with NCQA, URAC, CMS, and payer requirements for provider credentialing and enrollment.
• Assist with issue resolution and communication with payers regarding credentialing/enrollment status and delays.
• Upload and track CME documentation in relevant databases (e.g., CE Broker).
• Communicate credentialing or enrollment issues and application delays to the Manager in a timely manner.
• Participate in internal audits, special projects, and process improvements as directed.

Requirements

• Education and Experience: Healthcare administration, business, or a related field preferred. Minimum 2 years of experience in provider credentialing or enrollment, preferably in a healthcare, medical group, or managed care environment.
• Preferred Qualifications & Skills: Prior experience with delegated credentialing or payer audit support, experience using Athenahealth and VerityStream platforms, basic understanding of medical terminology and healthcare regulations, CPCS (Certified Provider Credentialing Specialist) certification preferred but not required.