Credentialing and Enrollment Coordinator
FoodsmartNutrition Tech company
United StatesMid
Kleiner Perkins
The Rise Fund
62 Ventures
Advocate Health
American College of Cardiology Foundation
Acequia Capital
Operations & Strategy
About the role
TL;DR
Coordinates healthcare provider credentialing and payer enrollment processes.
- •The Credentialing and Enrollment Coordinator supports the healthcare provider compliance process by verifying provider qualifications and managing the enrollment of groups and providers with government and commercial insurance payers.
- •This role ensures providers are properly credentialed and enrolled in a timely, accurate, and compliant manner.
- •Key Responsibilities Verify provider credentials and maintain provider profiles.
- •Conduct primary source verification and background checks.
- •Manage payer enrollment applications and track status.
- •Support compliance with regulatory standards like NCQA and CMS.
- •Communicate with providers, payers, and internal teams.
- •Requirements Minimum of 1 year of experience in Medicare and/or Medicaid enrollment.
- •Familiarity with CAQH, PECOS, NPPES, and state-specific enrollment portals.
- •Working knowledge of medical terminology and healthcare/CMS regulations.
- •Proficiency in data entry and management software.
- •Strong organizational and time management skills with attention to detail.
Required skills
Compliance ManagementProject Management
Domain expertise
healthcare