[Hiring] Credentialing and Provider Enrollment Coordinator @Ascension

Role Description

Complete the day to day credentialing/re-credentialing for all providers. Ensure the provider file from ACVS meets managed care criteria.

• Completes state specific credentialing verifications as necessary.
• Send newly credentialed rosters to all delegated payers.
• Complete and submit CAQH applications to all non-delegated payers.
• Run rosters for all delegated audits.
• Assist in audits related to credentialing/enrollment.
• Process provider data updates, changes and terms in MD Staff and submit to payers monthly.
• Follow up with payers to ensure new providers are loaded timely and correctly.
• Produce required documentation to meet payer and NCQA guidelines.
• Stays abreast of regulatory, legal and legislative issues and requirements and communicates changes.

Qualifications

• High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
• Required professional licensure/certification can be used in lieu of education or experience, if applicable.

Requirements

• 2 or 3 years of delegated credentialing experience, strongly preferred.
• 2 or 3 years of health plan experience, strongly preferred.

Benefits

• Paid time off (PTO)
• Various health insurance options & wellness plans
• Retirement benefits including employer match plans
• Long-term & short-term disability
• Employee assistance programs (EAP)
• Parental leave & adoption assistance
• Tuition reimbursement
• Ways to give back to your community