Credentialing and Provider Enrollment Coordinator

Job Description

Job Description

Description:

Balance Health empowers people to live full lives by improving and maintaining mobility. We bring together leading podiatrists, orthopedic surgeons, and physical therapists, providing them with the tools and resources to deliver exceptional patient care. Our mission has made us the largest lower-extremity focused physician-owned practice in the nation. 

As a Credentialing & Provider Enrollment Coordinator, you will play a critical role in ensuring providers are credentialed and enrolled accurately and on time. This position supports seamless operations and patient access by managing credentialing and payer enrollment processes, resolving issues, and collaborating across departments. 

Key Responsibilities

• Administer the provider credentialing process for practice providers and the provider enrollment process for insurance payers.
• Ensure timely communication with practices and implementation teams to gather credentialing and enrollment information.
• Process initial and re-credentialing applications and conduct primary source verification (CAQH, NPPES, etc.).
• Credential, link, and revalidate providers and groups with commercial and government payers.
• Maintain working knowledge of payer credentialing policies, forms, and compliance requirements.
• Troubleshoot and resolve enrollment issues, including claim denials and unbilled problems.
• Maintain accurate provider participation (PAR) lists and distribute updates to stakeholders.
• Enter provider demographics and credentialing data into credentialing software.
• Complete and track clearinghouse applications for EDI and ERA, and process EFT authorizations for payments.
• Collaborate with internal teams to develop and refine enrollment policies and procedures.
• Drive continuous improvement and contribute to special projects as needed.

What We’re Looking For

· Strong understanding of provider enrollment structure and processes.

· Excellent organizational skills and attention to detail.

· Outstanding written and verbal communication abilities.

· Creative, persistent problem solver with a client-service mindset.

· Ability to prioritize and multitask in a fast-paced environment.

· Proficiency in Microsoft Excel and credentialing software; strong data entry and typing skills.

· Commitment to confidentiality and accuracy.

Qualifications

Education:

· Associate or Bachelor’s degree in Healthcare Administration or related field preferred.

Certification:

· CPCS (Certified Provider Credentialing Specialist) preferred.

Experience:

· Minimum 3+ years of experience in healthcare payer enrollment and provider credentialing within a multi-specialty medical group.

· Experience working with government agencies such as CMS and AHCA strongly preferred.