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Credentialing & Enrollment Coordinator ($45k/year)
Revenue Cycle Management
Remote - US
Full Time

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Title/Position: Credentialing & Enrollment Coordinator

Department or Business Unit: Credentialing and Enrollment

Reporting Structure: Associate Director, National Credentialing & Payer Enrollment

Employment Type: FTE

Exemption Status: Exempt

Min. Experience: Entry/Mid-Level

Travel Required: None


Overview of the Role:


This person will be responsible for daily management of provider payer enrollment process, workflows, and updates to management & stakeholders. 


Primary Job Duties:


  • Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment
  • Accurately prepare all required paperwork for provider payor enrollment
  • Ability to build knowledge base of payer requirements and mechanisms for sharing knowledge with management and stakeholders
  • Responsible for roster preparation and managing payer requirements to ensure an efficient approach and execution of enrollment practices for all payers
  • Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
  • Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
  • Exercise independent judgment in interpreting NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to the credentials of PMG Providers
  • Record and track credentialing statistics

 

Minimum Qualifications:

  • Experience in a fast paced production environment 
  • Rigorous academic program acceptable experience
  • Highly skilled in utilization of excel to complete rosters and problem solve
  • Demonstrated skills in problem solving and analysis and resolution
  • Must be able to function independently once trained, possess demonstrated critical thinking skills 
  • Must comply with HIPAA rules and regulations

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