Enrollment Coordinator

Job Summary:

• This role is responsible for gathering and verifying healthcare practitioner information and tracking all compliance requirements related to the provider enrollment and re-credentialing process. The position ensures that all incoming applications are accurate, complete, and include the required licensing, certification, and supporting documentation. Responsibilities also include maintaining provider files, updating service locations, rendering provider information, licensure, and ownership records.

Key Responsibilities:

Provider Enrollment & Credentialing

• Review and prepare new provider enrollment packets for accuracy, completeness, and timely submission to insurance payers.
• Maintain current provider information to ensure timely reimbursement for services.
• Process provider enrollment and re-credentialing applications.

Documentation & Compliance

• Follow up with physicians to obtain required documentation for enrollment and re-credentialing.
• Send renewal reminders at least 30 days prior to credential expiration dates.
• Scan and maintain credential files while monitoring expiration dates.
• Notify administrators and the Enrollment Manager of upcoming deadlines.

Provider Data Management

• Maintain accurate provider information in the physician database and the NPPES system.
• Complete CAQH re-attestation every 120 days for all providers.
• Update service locations, provider demographics, licensure, and ownership information.

Payer Relations

• Maintain working knowledge of payer enrollment processes and policy updates.
• Contact insurance payers via phone, email, and written correspondence to follow up on enrollment applications.
• Ensure provider participation effective dates and identification numbers are received within the goal of 60 days from the payer's receipt of the application.
• Document all payer communications and retain copies of emails and correspondence for future reference.

Billing Support

• Conduct research and provide findings to the Billing Department to assist with claims issue resolution.

Required Skills & Experience:

• Minimum 2 years of experience in one of the following:
  • Insurance verification, billing, and/or provider relations, or
  • Medical insurance verification/provider relations.
• Working knowledge of insurance billing and provider operations within a large healthcare organization.
• Knowledge of Medicare and Medicaid policies and procedures.
• Proficiency in:
  • Microsoft Word
  • Microsoft Excel
  • Microsoft PowerPoint
• Experience using:
  • CAQH
  • NaviNet
  • ECHO
• Strong analytical, organizational, and critical-thinking skills.
• Excellent problem-solving abilities.
• Ability to collaborate effectively with stakeholders across all organizational levels.

Education:

Required

• High School Diploma or GED.

Preferred

• Associate's Degree.