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Provider Enrollment Coordinator

Provider Enrollment Coordinator

Job ID 
2018-2288
# of Openings 
1
Job Locations 
US-NJ-Marlton
Posted Date 
5/16/2018

More information about this job

Overview

PROVIDER ENROLLMENT COORDINATOR

Full Time Position

Monday to Friday/Days

Marlton Office, Building A

MUST have at least two years of credentialing experience

Responsible for preparing and submitting and tracking credentialing applications and supporting documentation for the purpose of enrolling providers with payers. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system, CAQH profile and related applications. Works under the supervision of the Director, Medical Affairs.

Responsibilities

  • Analysis the practitioner profile and accompanying documents, ensuring applicant eligibility.
  • Implements coordinates and monitors provider enrollment and credentialing process for initial and re-credentialing application
  • Works closely with provider to obtain missing documentation and/or signatures pertaining to provider enrollment
  • Confirms receipt of requested documents and identifies and responds to issues that require additional investigation and evaluation, validates discrepancies with provider and  facilitates process for payer participation.
  • Performs timely follows-ups and updates database on the status of application and to report to management and provider
  • Enters and maintains credentialing information into CFG credentialing database and CAQH profile
  • Monitors documentation expiration dates and acquires the current and updated documentation;
  • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers credentialing issues as they arise for enrollment and contracting matters.
  • Utilizes the credentialing database, optimizing efficiency, and performs document generation tracking and reporting.
  • Assists providers with completion of necessary forms, applications, etc.;
  • Assists Medical Affairs Department with special projects;
  • Other duties as assigned.
  • KNOWDLEDGE, SKILLS and ABILITIES

  • Ability to communicate effectively, both orally and in writing.
  • Knowledge of Medicare, Medicaid and Commercial Payer Provider Enrollment Process
  • Knowledge of NCQH Standards
  • Informational research skills.
  • Ability to manage and impart confidential information.
  • Database management skills including querying, reporting, and document generation.

Qualifications

  • Superb organizational skills and a detail orientation with ability to multitask and handle a number of files at one time.
  • Excellent follow up skills, documenting in credentialing database status of applications to report to management and providers on status of application(s)
  • Ability to work efficiently and independently
  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
  • Database management skills including querying, reporting, and document generation.
  • At least 2 years credentialing experience
  • Ability to communicate effectively, both orally and in writing with professionals of different levels-providers, clients, managers, state boards etc
  • Must be proficient in MS Outlook, Word and Excel
  • Must be able to prioritize work with administrative deadlines.

EOE M/V/F/D