Credentialing and Provider Enrollment Coordinator

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Balance Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

Healthcare Insurance • SaaS • B2B

Balance Health is the nation’s premier comprehensive lower-extremity focused Physician Practice, having formed the largest majority physician-owned podiatric medical organization in the United States through its merger with Weil Foot & Ankle Institute. It offers operational support to podiatrists, orthopedic surgeons, and physical therapists, allowing them to concentrate on delivering high-quality patient care and growing their practices. Balance Health aids in recruiting, HR billing and collections, accounting, technology, marketing, regulatory compliance, and more, catering to private practice needs. Moreover, Balance Health provides partners access to ancillary services such as pathology labs, MRIs, physical therapy services, and orthotic labs, which contribute to convenient patient care and additional revenue streams. By leveraging its size to enhance contracts and decrease costs, it supports value-based care while promoting clinical autonomy for its physicians, making it a dynamic partner for medical professionals committed to providing exceptional foot and ankle care.

📋 Description

• 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.

🎯 Requirements

• Associate or Bachelor’s degree in Healthcare Administration or related field preferred. • CPCS (Certified Provider Credentialing Specialist) preferred. • 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.