Job Summary

The Healthcare Provider Credentialing and Payer Enrollment Coordinator is responsible for ensuring that healthcare providers meet all credentialing requirements and are enrolled with insurance payers to provide services to patients. This role requires meticulous attention to detail, effective communication with providers and payers, and a thorough understanding of
credentialing and enrollment processes, regulatory requirements, and payer guidelines.

The position is responsible for supporting all provider credentialing and to identify opportunities, issues, and process improvement within these functions within the Revenue Cycle Services and support tools for provider license and credentialing data management.

Essential Functions

Managing the credentialing processes and outcomes for the clinics to ensure completed credentialing profiles for all providers. Ensure that healthcare providers meet all credentialing requirements and are enrolled with insurance payers to provide services to patients. Credentialing Coordinate and oversee the credentialing and re-credentialing processes for physicians and healthcare providers. Gather and verify healthcare provider information, including education, training, work history, licensure, and certifications. Submit credentialing applications and recredentialing documents to healthcare organizations, hospitals, and other relevant entities. Maintain up-to-date provider credentialing files in compliance with state, federal, and organizational standards. Monitor expiration dates for licensure, certifications, and insurance, ensuring timely renewals. Liaise with healthcare providers and credential committees to resolve discrepancies or issues. Payer Enrollment Facilitate the enrollment of healthcare providers with commercial insurance companies, Medicare, Medicaid, and other payers. Prepare and submit enrollment applications and support documentation for new providers. Track application statuses, follow up with payers, and resolve any issues to ensure timely approval. Monitor payer network participation requirements and keep providers compliant with enrollment obligations. Ensure accurate data entry into payer portals and internal systems for credentialing and enrollment processes. Compliance and Documentation Stay informed about changing regulations and payer policies affecting credentialing and enrollment. Maintain thorough documentation of all interactions, communications, and approvals. Ensure compliance with NCQA, CMS, URAC, The Joint Commission and other industry standards. Keep accurate and up-to-date records in credentialing databases and systems. Monitor and address expirations of licenses, certifications, and insurance policies. Conduct periodic audits of provider files to ensure accuracy and completeness. Collaboration and Communication Act as a liaison and primary point-of-contact between providers, payers, and healthcare facilities to address credentialing and enrollment inquiries. Provide guidance to healthcare providers regarding credentialing requirements and payer processes, including gathering necessary documentation. Resolve discrepancies, respond to inquiries, and follow up on pending applications. Collaborate with billing and operations teams to ensure provider participation status aligns with reimbursement processes. Identify opportunities to streamline and improve the credentialing process.

Required Qualifications

Minimum of HS Diploma or GED. Minimum of Two or more years in healthcare credentialing and payer enrollment

Preferred Qualifications

Familiarity with CAQH, PECOS, NPPES, and payer-specific portals. Certifications are preferred: Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM).

Physical Demands

Typically sitting at a desk/table

Location

Hybrid/Flexible Work Arrangement

Additional Information

This is a Part-Time [temporary/per diem/casual] position classified as Non-Exempt. The offered pay is based on the successful candidate’s qualifications and experience, department budget, and an internal equity review.

For information about benefits, please review Drexel’s Per Diem/Casual/Temporary Benefit Fact Sheet.

Special Instructions to the Applicant
Please make sure you upload your CV/resume and cover letter when submitting your application.

Additional Required Documents

A review of applicants will begin once a suitable candidate pool is identified.

 

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