01Overview
Description
Responsibilities
Manage end-to-end provider and facility credentialing and recredentialing processes for assigned client accounts.
Prepare, submit, track, and maintain payer enrollment and participation applications for Medicare, Medicaid, and all major commercial payers.
Verify provider and facility credentials, including state licenses, NPI, DEA, malpractice coverage, CAQH profiles, board certifications, accreditations,and other required documentation.
Maintain accurate, organized, and audit-ready credentialing records within internal databases, payer portals, and client systems.
Monitor application status and perform timely follow-ups with payers to ensure prompt approvals and minimize enrollment delays.
Communicate effectively with providers, facilities, payers, and internal stakeholders to resolve credentialing and enrollment issues.
Proactively monitor upcoming expirations and initiate renewals to ensure uninterrupted provider and facility participation in payer networks.
Collaborate with Contracting, Revenue Cycle Management (RCM), and Billing teams to align credentialing activities with payer contracts and claim submission readiness.
Prepare and share regular credentialing and enrollment status reports with clients, providing accurate updates on pending, approved, and outstanding items.
Stay current with CMS regulations, Medicare and Medicaid guidelines, NCQA standards, and commercial payer credentialing requirements to ensure compliance.
Requirements
Qualifications
Associate's or Bachelor's degree preferred, preferably in Healthcare Administration, Business Administration, or a related field.
Minimum 2 years of provider credentialing and payer enrollment experience, preferably within an RCM vendor, healthcare organization, or multi-client setting.
Solid knowledge of Medicare, Medicaid, and commercial payer credentialing and enrollment processes.
Hands-on experience with PECOS, CAQH, NPPES, payer portals, and credentialing/enrollment softwar .
