Credentialing and Enrollment Coordinator
4 days ago
Overview:
We are a mission-driven organization that prioritizes dignity, equity, and high-quality care. Our team is committed to fostering an anti-racist workplace and promoting racial equity.
About the Role:
The Healthcare Staff Accreditation Specialist will oversee the credentialing, privileging, re-credentialing, and enrollment processes for medical and behavioral staff throughout their employment lifecycle. This role ensures client safety, maintains high-quality care, and facilitates compliance with regulatory standards.
Key Responsibilities:
- Credentialing and Privileging:
- Conduct comprehensive initial and ongoing credentialing and privileging of healthcare providers, ensuring compliance with industry standards and regulatory requirements.
- Maintain thorough and organized electronic credentialing and privileging files, including licenses, certifications, and training documentation.
- Obtain and document primary and secondary source verifications as required.
- Produce and distribute status reports and summaries regularly and upon request.
- Provider Enrollment:
- Coordinate provider enrollment with Medicare, Medicaid, and commercial payers.
- Collaborate with the Revenue Cycle Team to ensure payer rosters are current with contracted providers.
- Maintain accurate tracking logs for Managed Care Organizations, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH databases.
- Compliance and Auditing:
- Track license and certification expirations, ensuring timely renewals for all providers.
- Proactively engage with providers and departments to solicit, validate, and store documentation.
- Create and maintain Standard Operating Procedures (SOPs) to ensure consistency and compliance in credentialing, privileging, and enrollment processes.
- Participate in regular audits and site or regulatory visits, providing documentation as required.
Requirements:
- Education and Certifications:
- An Associate's degree is required; a Bachelor's degree is preferred, ideally in HR, business, or a related field.
- A Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification is preferred.
- Experience:
- At least three years of administrative experience in a healthcare setting, with a minimum of two years in credentialing, privileging, and/or enrollment.
- Experience in a primarily digital administrative environment is preferred.
- Knowledge of credentialing and privileging requirements of government and accreditation bodies (HRSA, NCQA, The Joint Commission) is a plus.
Compensation:
The estimated salary for this role is $55,000 - $65,000 per year, depending on experience.
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