Credentialing and Administrative Coordinator

Credentialing and Administrative Coordinator administers the physician and mid-level payor enrollment and hospital privilege credentialing applications process. The position is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual providers and clients with payors and hospitals. In this role, you will ensure the setup of the clients for participation status in the EMR, prepare and submit applications, follow up on the status of applications and track the progress on all pending applications. Also, this role will be responsible for the schedule management and some operational projects with the practice's lead physician. 

Responsibilities include:

Implements the physician enrollment and hospital credentialing process for clients who request credentialing services.

Maintain the timelines on enrollment/credentialing schedules, communicate with providers and other departments to update as needed and maintain a strict level of confidentiality for all matters pertaining to provider credentials.

Communicate with billing and the office managers on updates as needed and explain payer information requirements.

Coordinates credentialing data needed for onboarding, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, CV, malpractice insurance and state insurance form.

Works closely with providers and practice managers to obtain missing documentation pertaining to the onboarding and reappointment process. Obtains required provider signatures and follows up with the entities on documentation submitted.

Maintains provider information and demographics for all providers.

Responds to internal and external inquiries on routine credentialing and contracting matters.

Monitors and advises clients on expirations including but not limited to: Medical License, DEA, CDS, COI, TB, Flu.

Create & maintain PECOS & NPPES.

Run OIG report on onboarding providers.

Maintain quarterly health plan rosters.

Create & maintain provider CAQH.

Provider hospital dues.

Perform other duties and responsibilities as required, assigned, or requested.

Qualifications:

High School Diploma or GED required. Bachelor’s degree preferred.

Minimum of 2 years credentialing experience.

Proficiency in Microsoft Office, particularly Excel, Word, and Outlook.

Knowledge of the Medicare, Medicaid & third-party provider enrollment processes.

Hospital privileging experience including but not limited too primary sourcing.

Proficiency in CAQH, PECOS & NPPES.