Credentialing and Provider Enrollment Coordinator

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Ascension Executive Recruitment

WebsiteLinkedInAll Job Openings

11 - 50 employees

💼 Consulting

📣 Marketing

📦 Logistics

Consulting • Marketing • Logistics

Ascension Executive Recruitment is a specialist brand placing senior candidates across a range of industries. The company focuses on recruiting for roles such as C-Suite, Director, Head of Function, and Senior Management positions. With a global reach in the Irish and international markets, Ascension has experience in handling confidential campaigns and matching clients with suitable candidates. Their thorough screening and interview process ensures that only qualified candidates are presented to clients, emphasizing quality, transparency, and commitment to equal opportunity.

📋 Description

• Complete the day-to-day credentialing and re-credentialing for all providers • Ensure provider files from ACVS meet managed care criteria • Complete 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 and enrollment • Process provider data updates, changes, and terms in MD Staff and submit them 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 • Stay abreast of regulatory, legal, and legislative issues and communicate changes

🎯 Requirements

• 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 • 2 or 3 years of delegated credentialing experience strongly preferred • 2 or 3 years of health plan experience strongly preferred • Knowledge of managed care criteria, payer requirements, and NCQA guidelines • Ability to complete state-specific credentialing verifications • Ability to complete and submit CAQH applications • Ability to process provider data in MD Staff • Ability to conduct or assist with credentialing/enrollment audits • Ability to monitor regulatory, legal, and legislative requirements

🏖️ 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