Enrollment Coordinator

Equiliem; Philadelphia (Philadelphia County); On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Medical Insurance

Vision & Dental Insurance

Life Insurance

Matching 401(k)

Commuter Benefits

Employee Discounts & Rewards

Payroll Payment Options

Job summary

Equiliem seeks an Enrollment & Credentialing Coordinator to gather and verify healthcare practitioner information and manage compliance documentation for enrollment and re-credentialing.

You will ensure licensing and certification documentation is complete and up to date, and perform file maintenance including updating service locations and provider data. Strong attention to detail is essential.

Qualifications

• At least two (2) years previous experience with insurance verification, billing and/or provider relations.
• At least two (2) years medical insurance verification/provider relations.
• Working knowledge of insurance billing/provider operations within a large healthcare organization.
• Knowledge of Medicare and Medicaid policies and procedures.
• Basic proficiency with MS Word, Power Point, Excel computer programs.
• Knowledge of the ECHO, NAVINET and CAQH systems.
• Solid critical thinking / problem-solving skills.
• Solid analytical and organizational skills.
• Ability to collaborate with stakeholders at all levels.

Responsibilities

• Provides reviews and prepares new hire enrollment packets for accuracy, completeness and timely submission to the payers and maintains current provider information in order to ensure timely reimbursement of payment for services.
• Performs follow-up with the physicians to request necessary documentation for the application/re-credentialing process (Renewal reminders must be sent 30 days prior to the expiration date).
• Maintains a working knowledge of payers' processes and updates and ensures that the physician database and NPPES system is kept accurate and current. CAQH re-attestation to occur every 120 days for all providers.
• Maintains files, scans credentials and monitors expiration dates and notifies administrators and Enrollment Manager of deadlines.
• Initiates phone calls, generates letters and other correspondence as required for follow up with payers to ensure timely receipt of provider participation effective dates and numbers (goal is within 60 days of payer receipt date of the application).
• Assures that all contacts and discussion with payers are documented and maintained, as well as copies of emails and/or written correspondence sent to third party payers, for future reference.
• Reviews and provides research results to the Billing Department to assist with claims issue resolution.

Skills

Insurance verification

Billing

Provider relations

Medicare/Medicaid policies

MS Word/PowerPoint/Excel

ECHO NAVINET CAQH systems

Critical thinking

Analytical skills

Organizational skills

Stakeholder collaboration

Education

High School Diploma/GED

Associate's Degree

Tools

ECHO system

NAVINET system

CAQH system

NPPES system

Job description

Job Summary

This role is responsible for gathering and verifying healthcare practitioner information and tracking all compliance information related to the enrollment and re-credentialing process. This includes processing all incoming applications to ensure accuracy at completion and that all required licensing and certification documentation is present, as well as all additional required documentation. All necessary file maintenance functions, including updating service locations, rendering provider information; licensure and ownership information is also a function of this position.

Job Responsibilities

• Provides reviews and prepares new hire enrollment packets for accuracy, completeness and timely submission to the payers and maintains current provider information in order to ensure timely reimbursement of payment for services.
• Performs follow-up with the physicians to request necessary documentation for the application/re-credentialing process (Renewal reminders must be sent 30 days prior to the expiration date).
• Maintains a working knowledge of payers' processes and updates and ensures that the physician database and NPPES system is kept accurate and current. CAQH re-attestation to occur every 120 days for all providers.
• Maintains files, scans credentials and monitors expiration dates and notifies administrators and Enrollment Manager of deadlines.
• Initiates phone calls, generates letters and other correspondence as required for follow up with payers to ensure timely receipt of provider participation effective dates and numbers (goal is within 60 days of payer receipt date of the application).
• Assures that all contacts and discussion with payers are documented and maintained, as well as copies of emails and/or written correspondence sent to third party payers, for future reference.
• Reviews and provides research results to the Billing Department to assist with claims issue resolution.

Required Skills & Experience

• At least two (2) years previous experience with insurance verification, billing and/or provider relations.
• At least two (2) years medical insurance verification/provider relations.
• Working knowledge of insurance billing/provider operations within a large healthcare organization.
• Knowledge of Medicare and Medicaid policies and procedures.
• Basic proficiency with MS Word, Power Point, Excel computer programs.
• Knowledge of the ECHO, NAVINET and CAQH systems.
• Solid critical thinking / problem-solving skills.
• Solid analytical and organizational skills.
• Ability to collaborate with stakeholders at all levels.

Preferred Skills & Experience

• N/A

Required Education

• High School Diploma/GED.

Preferred Education

• Associate's Degree

Required Certifications & Licensure

• N/A

Preferred Certifications & Licensure

• N/A

About Equiliem

Equiliem believes in empowering success. It's our job to cultivate relationships that connect people and employers in a way that is inclusive, intelligent, and allows both to thrive.

Across the U.S., leading companies in healthcare, government, engineering, manufacturing, professional services, and energy rely on us for their workforce solutions. Our recruiting and HR services include contract and direct hire staffing, Payrolling/EOR, Independent Contractor Compliance, and Managed Services.

For almost 30 years, we've helped shape our industry. Today, we continue to research, ask questions, and continuously enhance the candidate journey and client experience.

Benefits

We offer a comprehensive benefits package to our employees, which includes:

• Medical Insurance
• Vision & Dental Insurance
• Life Insurance
• Matching 401(k)
• Commuter Benefits
• Employee Discounts & Rewards
• Payroll Payment Options

Future Communication Consent

By applying, you are providing consent for Equiliem to engage with you via phone calls, AI-generated calls, AI-generated text messages, standard text messages, and/or emails to share job opportunities. Consistent with our Privacy Policy, information obtained will not be shared with third parties for marketing or promotional purposes. Message frequency may vary for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You may reply STOP to cancel or HELP for assistance.

EEO Employer

Equiliem is an equal opportunity employer. We do not discriminate or allow discrimination based on race, color, religion, creed, sex, age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Equiliem will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [emailprotected] or [phone].