Credentialing Coordinator - Full Time

MercyOne; Des Moines (IA); On-site; USD 65,000 - 75,000; Full time

Job summary

MercyOne is seeking a Credentialing Specialist to ensure practitioners and facilities are credentialed with participating insurance plans and to maintain compliance with regulatory standards.

You will build positive relationships with payers, practitioners, and internal teams while serving as a resource for credentialing inquiries and issues. This full-time role focuses on payer enrollment, NPI/CAQH management, and accurate enrollment processing.

Qualifications

• Must have knowledge of payer credentialing and enrollment.
• Bachelor’s degree preferred.
• 4+ years in health care operations, payer enrollment, or medical staff services.

Responsibilities

• Understand payer rules, regulations, and enrollment processes.
• Assist providers with access and maintenance of NPI and CAQH accounts.
• Coordinate and complete provider and facility enrollments as assigned.
• Ensure enrollment activities meet payer requirements.
• Create and maintain enrollment spreadsheets.

Skills

Payer credentialing knowledge

Excel proficiency

Interpersonal skills

Attention to detail

Education

Bachelor’s degree preferred

Tools

Enrollment software

Job description

Employment Type:Full timeShift:Day ShiftDescription:

Job Summary

Performs the necessary activities to ensure practitioners and facilities are credentialed/recredentialed with participating insurance plans in compliance with regulatory standards and in accordance with policies and procedures. Builds and maintains positive relationships with payers, practitioners, and internal teams. Serves as a resource regarding insurance credentialing issues, concerns, and inquiries.

Job Duties

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
• Understand the various payer rules, regulations, and enrollment processes.
• Assists providers with access and maintenance of NPI and CAQH accounts as needed.
• Coordinate and complete provider and facility enrollments as assigned.
• Ensure all enrollment activities are completed fully and accurately based on each payer enrollment requirements.
• Demonstrate the ability to create and maintain various internal and external enrollment spreadsheets.

Hours

Full Time

40 hours/week

Minimum Qualifications

• Must possess a knowledge of payer credentialing and enrollment through a combination of education and experience.
• Bachelor’s degree preferred
• At least 4 years of health care operations, payer enrollment, or medical staff services experience.
• Must possess high attention to detail with the ability to prioritize competing tasks and work independently with little oversight.
• Must have strong interpersonal skills with a focus on customer service.
• Must be comfortable with Excel functions and possess strong computer literacy skills.
• Previous experience with credentialing and enrollment software (or database management) is preferred.
• Ability to become certified if required.
• Must be comfortable operating in a collaborative, shared leadership environment.
• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Colleagues of MercyOne Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout the system!

Visit MercyOne Careers to learn more about the benefits, culture, and career development opportunities available to you at MercyOne Health System circle of care

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.