Credentialing & Enrollment Coordinator

Credentialing & Enrollment Coordinator

12 week/Temp-to-hire

Hybrid Schedule - Reporting to Coppell, TX.

Competitive pay

Job Description:

Summary of Position

The Credentialing and Enrollment Coordinator is responsible for performing and maintaining the enrollment and credentialing process for health insurance plans, state Medicaid entities, and Medicare for all company-owned entities. Included in these activities are the processing of Commercial and Governmental applications and re-applications, initial mailing, review, and loading into the database tracking system ensuring timing and quality standards are maintained. Additionally, the Credentialing and Enrollment Coordinator must have the ability to prioritize and organize complex activities/projects and track progress as well as work effectively and collaboratively with others. The ideal candidate will possess contract administration experience, including appropriate analytical skills, attention to detail, and will be able to work independently.

Key Job Elements

• Securing and maintaining all health insurance plan enrollment and re-enrollment for the Company
• Perform necessary follow-up with appropriate state and federal agencies
• Completing commercial plan facility credentialing and re-credentialing forms for the Director of Managed Care
• Securing Electronic Funds Transfer form with appropriate Company authorized signature
• Create and maintain web portal registration for executed contracts
• Manage the controlled flow of contract documents through the company to secure appropriate Legal review and Executive signatures
• Maintain Commercial Contract Summary Log
• Maintain government entity Tracking log
• Maintain department files in an organized, accurate, secure manner.
• Manage incoming and outgoing departmental mail.
• Process credentialing applications/enrollments and the supporting documentation.

o Enroll entities in Medicare and revalidate information, as necessary.

o Enroll entities in State Medicaid programs and revalidate information as necessary.

o Complete commercial health plan credentialing and recredentialing documents for all entities.

o Complete credentialing and recredentialing documentations for all entities which require physician credentialing.

• Track license and certification expirations to confirm renewals.
• Maintain accurate information for entities, updating their credentials as necessary.
• Perform data entry into databases or systems.
• Responsible for health plan/government entity provider-related communications pertaining to credentialing/enrollment.
• Respond to internal and external customer inquiries regarding credentialing/enrollment status.
• Perform other duties, as required, or assigned.

Knowledge/Experience

• High School diploma or equivalent is required.
• Bachelor degree preferred.
• One plus (1+) years of experience in healthcare contracting.
• Computer skills to include Word, Excel, Power Point, Outlook.
• Strong interpersonal and communication skills, both written and oral, with varying levels of colleagues and/or management.
• Ability to manage open projects to the end with successful follow up.
• Attention to detail and strong organization skills.
• Ability to work independently within guidelines and company policies.
• Ability to effectively present information and respond to questions from managers, clients, and customers.