Credentialing and Enrollment Coordinator

Job not on LinkedIn

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $60k - $70k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Foodsmart

WebsiteLinkedInAll Job Openings

51 - 200 employees

🍽️ Food & Beverage

🏥 Healthcare

⚕️ Healthcare Insurance

Food & Beverage • Healthcare • Healthcare Insurance

Foodsmart is a company focused on providing personalized nutrition support and affordable food care through the guidance of registered dietitians. It offers tools such as meal planning, food delivery via partnerships with Instacart, Grubhub, and Walmart, and a food marketplace that helps users save money on groceries. Foodsmart also works with health plans to offer nutrition services to its members, often at no extra cost.

📋 Description

• Verify provider qualifications and manage enrollment of groups and providers with government and commercial insurance payers • Collect, verify, and maintain provider credentials, including education, licensure, board certification, DEA registration, malpractice insurance, and work history • Conduct primary source verification of licenses, certifications, and education through official sources • Support compliance efforts with regulatory and accrediting institutions • Maintain and update provider profiles in CAQH through the Group Profile • Track credential expiration dates and initiate renewals • Prepare providers for credentialing committee review and respond to requests for additional information • Conduct or review background checks, NPDB queries, and OIG/SAM exclusion list checks • Maintain compliance with NCQA, CMS, or state-specific credentialing standards • Enroll providers with Medicare, Medicaid, and commercial insurance payers • Complete and submit payer enrollment applications • Track application status and follow up with payers to resolve delays or denials • Link providers to group practices and tax ID numbers with appropriate payers • Process provider terminations, updates, and re-validations with payers • Coordinate enrollment effective dates with billing and revenue cycle teams to avoid claim denials • Input provider information into credentialing and enrollment databases and systems • Maintain data accuracy and confidentiality • Generate basic credentialing and enrollment reports • Respond to provider and payer inquiries and support provider education on enrollment requirements • Work with the Credentialing and Enrollment Team, Clinical Operations, and clinical staff to uphold professional practice and regulatory compliance

🎯 Requirements

• Minimum of 1 year of experience in Medicare and/or Medicaid enrollment • Familiarity with CAQH, PECOS, NPPES, and state-specific enrollment portals • Working knowledge of medical terminology and healthcare/CMS regulations • Proficiency in data entry and management software • Strong organizational and time management skills with demonstrated attention to detail • Ability to manage multiple complex projects and consistently meet deadlines • Excellent written and verbal communication skills • Ability to work independently and collaboratively within a team environment • Commitment to maintaining confidentiality of sensitive information • Candidates must reside in and work within the US

🏖️ Benefits

• Remote-First Company • Unlimited PTO • Flexible & remote location • Healthcare Coverage (Medical, Dental, Vision) • 401k & bonus • Registered Dietitian Sessions