Provider Enrollment Maintenance Coordinator

Job Description

The Provider Enrollment Maintenance Coordinator is responsible for proactively completing all provider enrollment maintenance activities, minimizing any lapses in clinician enrollment, and ensuring that write-offs/holds related to maintenance activities are minimized. This position is also responsible for verifying maintenance requirements, ensuring the centralized payer library is current, and communicating updates to management and colleagues.

Essential Duties and Responsibilities

• Complete all maintenance activities including research, recording, communication & information sharing, submission, confirmation and follow-up
• Maintenance activities include, but are not limited to: Medicare & Medicaid revalidations, re-credentialing for all payers, creation and maintenance of CAQH practice and clinician profiles, submission of clinician updates e.g. licensure and certificates of insurance to payers, completion of any/all requests for data validation from payers and internal customers
• Manage roster submission, review and data entry
• Collaborate with colleagues to resolve enrollment related denials associated with maintenance
• Collaborate with analyst and/or HCFS to proactively monitor enrollment status for payers that require claim activity to remain participating
• Partner with Lead to communicate any application, roster or payer required form updates
• Occasional overtime and/or participation on special projects may be required

Qualifications / Experience

• Ability to operate effectively in a fast-paced environment
• Display a high standard of professional conduct to include punctuality, job consciousness and dependability
• Perform with a high degree of accuracy; give meticulous attention to detail
• Work harmoniously and effectively across all levels of the business; cooperate with others for the benefit of the organization
• Show genuine interest in continuous development in professional and technical skills

Requirements

• High school diploma or equivalent; some college preferred
• One year of experience with health care or comparable industry