Remote Provider Enrollment Coordinator

* Receives notifications from the Clinician Onboarding Liaison (COL).
* Work closely with recruiting team during the onboarding process of new providers and provide weekly credentialing updates as to status of enrollment with payors.
* Obtain and maintain provider credentialing documents for new and existing providers, including expiring documentation.
* Provides timely and pertinent information on providers for Credentialing Committee review and approval.
* Escalates Provider Credentialing issues to the Director, as needed.
* Escalates payor issues to Director, as needed.
* Tracks, generates, and prepares applications to send to provider.
* Conducts payer research on the provider.
* Adds providers to the Credentialing report.
* Reviews returned packets for accuracy and communicates updates to the Providers.
* Review weekly exception reports from management to prioritize critical issues.
* Follows up with providers for un-returned paperwork.
* Sends updated credentials to the payer and complete payer credentialing applications for new facility locations in multiple states.
* Research state requirements prior to entry into the state and creates SOP regarding same.
* Works with Director and other key stakeholders on all new facilities including enrollment of facilities and individual locations into new markets.
* Keeps all key stakeholders informed of any challenges faced in new markets.
* Primary point of contact for withdrawal of provider's employment; receive and update and notify others, if needed.
* Generate correct payer paperwork for re-validations/begin re-credentialing process.
* Partner with COL, credentialing coordinators and other key stake holders in onboarding and enrollment providers and facilities with Medicaid, Medicare, commercial and managed care plans.
* Maintenance of provider enrollment processes and credentialing databases/websites/portals including CAQH, NPPES, Navinet, Availity, PECOS.
* Support overall Provider Enrollment Department, assist contracting department with requests as necessary and work with RCM to assist with payer issues related to credentialing.
* Meets at least monthly with health plans (more if needed) to obtain statuses of providers and to address any claims issues including holds and denials.
* Works with payors to ensure timely enrollment & active status.
* Escalates trends and issues to RCM, operations, and other key stake holders as needed.
* Minimum of 2 years of successful work experience in physician credentialing and/or physician enrollment.
* Experience with provider credentialing databases/websites/portals (i.e.

- CAQH, NPPES and PECOS).
* Experience with Modio software preferred.
* Working knowledge of the revenue cycle process.
* Overtime may be required by Management.
* Medical, Dental, and Vision Insurance
* PTO* Variety of 401K options including a match program with no vesture period
* Annual Continuing Education Allowance (in related field)
* Life Insurance
* Short/Long Term Disability
* Paid maternity/paternity leave
* Mental Health day
* * Calm* subscription for all employees
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