Credentialing Coordinator, FT, Days

🔥 15 hours ago

🏈 Alabama, Arizona, +26 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 12%

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Connections Health Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

🏥 Healthcare

🏛️ Government

💰 $28M SERIES B on 2023-09

Healthcare • Government

Connections Health Solutions is a behavioral health services organization that operates 24/7 walk-in mental health crisis centers and crisis stabilization units across multiple U. S. communities. It provides immediate-access crisis care (including walk-in clinics, short-term stabilization, extended/subacute stabilization, and recovery support/coaching), accepts all individuals regardless of insurance, and partners with local governments, managed care organizations, and health systems to design and operate community crisis care systems. Connections also produces education and thought leadership on crisis care best practices and expands access through partnerships and new center openings.

📋 Description

• Manage the end-to-end credentialing, re-credentialing, and payer enrollment process for behavioral health providers, behavioral health support staff, and facilities • Manage new provider onboarding from HR/Talent Acquisition notification through completion of the Medallion profile • Enter and maintain provider information including NPI, licensure, practice locations, and payer information • Request required documentation including CAQH, PECOS, state licenses, DEA registrations, board certifications, diplomas, and other credentials; track completion • Communicate with physicians and providers by phone, text, and email to explain requirements, resolve outstanding items, and answer questions • Research and interpret state licensing, supervision, collaborative agreement, and scope-of-practice requirements • Complete primary source verifications including NPI, NPDB, Medicare/Medicaid opt-out, state licensure, DEA, OIG, and SAM checks • Escalate adverse findings through the credentialing committee review process • Coordinate malpractice policy additions and upload insurance documentation to the credentialing platform and CAQH • Manage commercial and government payer enrollment applications, effective dates, payer IDs, and recredentialing dates • Maintain and re-attest provider CAQH profiles • Support cross-state licensure and payer enrollment for telehealth providers • Facilitate state and program-specific registrations, Medicaid portal enrollment, domain transfers, surrogacy requests, and Medicare enrollment through CMS/PECOS • Manage NPI acquisition and state Medicaid enrollment for behavioral health support staff; distribute compliance reports • Manage facility-level enrollment and maintenance in state Medicaid systems • Process provider and BHS staff terminations and notify applicable payers • Monitor OIG/SAM and NPDB databases, license renewals, board certifications, and recredentialing cycles • Complete credentialing documentation under delegated credentialing requirements • Partner with HR, Talent Acquisition, Medical Leadership, and operational leadership • Participate in quarterly Credentialing Committee meetings and prepare regular status reporting • Support standardized credentialing workflows, reference guides, process documentation, and SOPs • Perform other duties and responsibilities as assigned

🎯 Requirements

• High school diploma or equivalent required • 2 years of experience in provider and/or facility credentialing, payer enrollment, or related managed care administrative work • General knowledge of regulatory requirements related to credentialing and payer enrollment, including Medicare, Medicaid, and managed care processes and rules • Ability to research and interpret state licensing board requirements across MD, DO, NP, and PA provider types • Experience working within a credentialing software platform such as Medallion or a comparable credentialing management system • Working knowledge of PECOS, CAQH, and state Medicaid provider portals • Strong customer service orientation and soft skills, with comfort communicating by phone, text, and email with physicians and providers • Advanced user of Microsoft Office products, particularly Excel • Must be fully vaccinated with documentation, or exempt through the company exemption process, prior to start date • Preferred: Bachelor's degree in health care administration or a related field • Preferred: 3+ years of credentialing or payer enrollment experience within a behavioral health environment • Preferred: Familiarity with CAQH attestation processes and delegated credentialing requirements • Preferred: Experience supporting multi-market or multi-state credentialing and enrollment operations

🏖️ Benefits

• Employees (and their families) are offered comprehensive health insurance, including Medical, Dental, Vision, Accident, Critical Illness, and Hospital Indemnity • CHS pays for Basic Life, AD&D, Short and Long-Term Disability • Voluntary Life insurance option for employees and their families • Health Savings Accounts with $1,000 to $2,000 employer contribution depending on plan • Flexible Spending Accounts for health care and dependent care • 401k company match after 6 months (50% of deferrals up to 6% of compensation) • Generous PTO starting at 160 hours accrued annually • 12 recognized company holidays • Company-paid parental leave available to eligible employees • Employee Assistance Program providing confidential emotional support, work life solutions, financial solutions, legal assistance, and online support • After 90 days, auto-enrollment in the 401k Plan

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