Provider Enrollment Coordinator

POSITION SUMMARYThe Provider Enrollment Coordinator is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual clinicians and provider groups with payers. In this role, you will ensure the setup of the clients for electronic claims submission and electronic remittance advice. You will follow up on the status of applications for clinicians and payers and track the progress on all pending applications. The primary responsibility will be to collect and manage all credentialing documents for our providers, submit enrollment applications to insurance companies and track their progress. Coordinate on boarding documents with recruiting and hospital credentialing.ROLES & RESPONSIBILITIESESSENTIAL FUNCTIONS AND BASIC DUTIESCollect and manage all credentialing documents for providers payer enrollmentRegister providers with CAQH, along with managing organization linkageSubmit enrollment applications to insurance companies and follow-up until enrollment is completedKeep up to date provider enrollment processes and track provider participation levelsComplete re-credentialing for established providers as required by payersEnter and maintain all Provider information in the credentialing databaseMeet required turnaround times and accuracy ratesPerform ongoing research to correct data so it does not create duplicate provider, locations, payees, and participationsInteracts with physicians, physician office personnel, hospital personnel, insurance company personnel and patients demonstrating superior customer serviceMaximizes the use of available technologies to improve revenue cycle workflow and maximize collectionsPerforms other duties as necessary or assignedConducts job duties in accordance with the Corporate Values and Culture - Others First - Others before self - Wisdom - Do the wise thing - Growth - Keep getting betterQUALIFICATIONS - EDUCATION, WORK EXPERIENCE, CERTIFICATIONS Education/Certification: High School Diploma or equivalent0-3 years of experience in medical terminologySome experience in provider enrollment is preferred (less than 3 yrs)KNOWLEDGE, SKILLS, AND ABILITIESKnowledge of medical insurance carrier policies and procedures, and State and Federal rules and regulationsMedicare, Medicaid, and Commercial Payer Provider Enrollment knowledgeKnowledge of PECOSWorking knowledge for CMD Skills/abilitiesStrong organizational, planning, and decision-making skillsAbility to adapt to a changing environmentStrong written and verbal communication skillsAbility to work effectively in a fast-paced environmentProficiency in Microsoft Office, particularly Excel and WordProfessional written and verbal communication and interpersonal skills requireAbility to effectively communicate with team members, supervisors, client staff and insurance contactsAbility to maintain complete confidentiality in handling sensitive enrollment issues

Created: 2025-03-03