Payer Enrollment & Credentialing Specialist

Charleston Area Medical Center; Charleston (WV); On-site; USD 55,000 - 75,000; Full time

Job summary

Charleston Area Medical Center is seeking a Credentialing Coordinator to administer the credentialing process for WVPHO members, coordinating enrollment with plans and maintaining data accuracy. The role supports other department projects and responds to verification requests from internal and external customers.

The position emphasizes data integrity, proactive problem resolution, and world-class customer service via phone, email, and in-person meetings.

Qualifications

• Bachelor's Degree in business or healthcare administration.
• Preferred credentialing or Medical Staff Office experience.
• Proficient with MS Word, Excel and Access for reporting and data analysis.

Responsibilities

• Follows up on physician enrollment status with contracted plans by building relationships with plan representatives.
• Evaluates claim problems to determine if related to enrollment or other error and resolves accordingly.
• Identifies data disparities between plan sources and Managed Care database to limit revenue impact and denials.
• Coordinates enrollment and credentialing for delegated and non-delegated plans, Medicare, and Medicaid.
• Maintains internal and external databases with physician information, demographics, and terminations.
• Responds to verification requests from internal and external customers.

Skills

Data analysis

Time management

Interpersonal skills

Education

Bachelor's Degree (Required)

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

Charleston Area Medical Center is seeking a Credentialing Coordinator to administer the credentialing process for WVPHO members, coordinating enrollment with plans and maintaining data accuracy. The role supports other department projects and responds to verification requests from internal and external customers.

The position emphasizes data integrity, proactive problem resolution, and world-class customer service via phone, email, and in-person meetings.