Payor Enrollment Coordinator
Description
Financial Credentialing Duties:
• Builds and maintains CAQH profile for each provider
• Initiates and tracks provider enrollment with Medicaid, Medicare, and multiple commercial health plans
• Monitors multiple communication formats used by payers
• Develops and maintains provider enrollment processes manual
• Analyses complex financial credentialing resulting in delays or denials, makes correction to enrollments as needed to resolve circumstance
• Actively develops and conducts communication processes that ensure that all appropriate staff and agencies are kept updated as to progress in financial credentialing
• Provides Executives with weekly status reports and additional reports as requested
• Conducts weekly meetings with all stakeholders to discuss progress, denials, and other topics as needed
• Assists providers with completion of applications and credentialing paperwork
• Coordinates with staff and outside agencies to obtain necessary information to perform the credentialing process
• Follows-up with insurance companies regarding provider participation status
• Retains detailed and accurate records of insurance companies with which providers are credentialed
• Prepares for, and participates in, credentialing audits by outside agencies
• Actively develops and conducts communication processes that ensure that all appropriate staff and agencies are kept updated as to progress in financial credentialing
Qualifications:
• Comprehensive knowledge of Medicaid, Medicare, and Commercial health plan credentialing requirements and processes
• Proven success at developing relationships with internal teams and external stakeholders to enhance teamwork and achieve shared goals
• Strong ability to manage multiple tasks, analyze complex issues, and implement effective solutions
• Works independently, managing workloads and priorities with minimal supervision
• Thrives in dynamic, challenging environments, maintaining efficiency and effectiveness under pressure
• Takes initiative to identify areas for improvement and implement strategic solutions
• Demonstrates clear, adaptable written and verbal communication skills tailored to diverse audiences
• Effectively leads projects, delivering results on time with precision and mindfulness
• Strong understanding of intermediate-to-advanced medical terminology
• Skilled in standard office software applications, including Microsoft Outlook, Microsoft Office, and Teams
Education/Experience:
• Bachelor’s degree in business or related field
• At least five (5) years of experience working in an acute health care setting with a specific background in financial credentialing with payers
• Extensive provider credentialing experience in a healthcare facilities setting is required
The above is intended to describe general content and requirements for the performance of this position. It is not to be construed as an exhaustive statement of duties, responsibilities, or other requirements.
We are an E-Verify employer.
For more information, please click on the following links:
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