Provider Enrollment & Credentialing Specialist

Children's Hospital of Philadelphia; Philadelphia (Philadelphia County); On-site; USD 35,000 - 44,000; Full time

Job summary

Children's Hospital of Philadelphia (CHOP) is seeking an experienced enrollment and credentialing coordinator to gather and verify healthcare practitioner information, ensure licensing and documentation are complete, and maintain provider records.

You will manage payers' enrollment and re-credentialing, monitor expirations, coordinate with Billing and Enrollment Managers, and keep CAQH/NAVINET/ECHO systems up to date to support timely reimbursements.

Qualifications

• Education and two years of insurance verification or billing experience required.
• Experience with payer enrollment or provider relations is required.
• Familiarity with CAQH, NAVINET and ECHO systems preferred.

Responsibilities

• Prepare new hire enrollment packets for accuracy and timely submission to payers.
• Maintain physician database and CAQH re-attestation every 120 days.
• Maintain files, scan credentials and monitor expiration dates.
• Initiate follow-up with payers to ensure timely provider participation dates and numbers.
• Support claims issue resolution by providing research to Billing.

Skills

Insurance verification

Billing processes

Provider relations

Medicare/Medicaid policies

MS Word/PowerPoint/Excel

CAQH NAVINET ECHO systems

Analytical thinking

Organizational skills

Collaboration with stakeholders

Education

High School Diploma / GED

Associate's Degree Preferred

Tools

CAQH

NAVINET

ECHO

MS Word

Excel

PowerPoint

Job description

Children's Hospital of Philadelphia (CHOP) is seeking an experienced enrollment and credentialing coordinator to gather and verify healthcare practitioner information, ensure licensing and documentation are complete, and maintain provider records.

You will manage payers' enrollment and re-credentialing, monitor expirations, coordinate with Billing and Enrollment Managers, and keep CAQH/NAVINET/ECHO systems up to date to support timely reimbursements.