Provider Credentialing & Enrollment Coordinator

Treatment Centers Hold Co, LLC; United States; Remote; USD 28,000 - 41,000; Part time

Benefits offered by this job

Mileage reimbursement

Calm subscription

Excellent training for newcomers

Opportunity to save lives every day

Job summary

Crossroads Treatment Centers is seeking an Enrollment Coordinator to support provider onboarding, credentialing, and enrollment with payors. You will work closely with the Clinician Onboarding Liaison and the recruiting team to maintain timely credentialing updates and ensure smooth enrollment across multiple states.

The role requires at least 2 years in physician credentialing, familiarity with CAQH, NPPES and PECOS, and experience with Modio.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Physician credentialing

Enrollment processes

Revenue cycle knowledge

Tools

CAQH

NPPES

PECOS

Modio

Job description

Crossroads Treatment Centers is seeking an Enrollment Coordinator to support provider onboarding, credentialing, and enrollment with payors. You will work closely with the Clinician Onboarding Liaison and the recruiting team to maintain timely credentialing updates and ensure smooth enrollment across multiple states.

The role requires at least 2 years in physician credentialing, familiarity with CAQH, NPPES and PECOS, and experience with Modio.