Credentialing and Payer Contracting Coordinator

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $5 - $15 / hour

⏳ Contract/Temporary

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Legion Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2021

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 Seed Round on 2024-09

Consulting • Insurance • Healthcare

Legion Health is a provider of world-class psychiatric care, making mental health services accessible to everyone. With a team of board-certified providers and guided by top psychiatric experts, Legion Health offers a tailored, affordable approach to mental wellness. Their services include comprehensive evaluations, personalized follow-up schedules, and coordination with other members of the care team, all provided through a secure telemedicine platform for convenience and comfort.

📋 Description

• Coordinate initial credentialing, payer enrollment, and recredentialing for new and existing clinicians. • Collect, review, and organize provider documentation, including licenses, DEA registrations where applicable, malpractice coverage, CVs, education and work history, board certifications, W-9s, NPIs, taxonomy codes, disclosures, and attestations. • Maintain accurate provider profiles in CAQH ProView, NPPES, PECOS, state Medicaid systems, commercial payer portals, and internal tracking systems. • Prepare, submit, and track enrollment applications, roster additions, demographic changes, service-location updates, reassignment requests, terminations, and payer requests for additional information. • Follow up with payer representatives through phone, email, portals, and ticketing systems; document interactions and escalate stalled or time-sensitive applications. • Support the payer-contracting lifecycle, including network-interest submissions, contracting applications, agreement intake, fee-schedule organization, redline tracking, signature routing, amendments, and renewals. • Route reimbursement, legal, and operational terms to appropriate internal decision-makers for review and approval. • Maintain a reliable source of truth for each provider and payer, including application status, participating plans, contract status, effective dates, rates, renewal dates, outstanding items, owners, and next follow-up dates. • Coordinate with provider operations, revenue cycle, finance, legal, and billing teams to confirm credentialing, contracting, roster loading, and billing setup are complete before providers are marked ready to bill. • Monitor licenses, attestations, recredentialing deadlines, contract renewals, and other expirations. • Investigate discrepancies across provider records, payer portals, contracts, directories, and internal systems and drive issues through verified resolution. • Track turnaround times, aging applications, deadlines, payer bottlenecks, and operational risks through weekly reporting. • Identify recurring issues and improve workflows through templates, checklists, documentation, automation, and escalation paths. • Protect provider and patient information by following privacy, security, and access-control requirements.

🎯 Requirements

• 2+ years of experience in provider credentialing, payer enrollment, contract administration, provider operations, medical-staff services, revenue-cycle operations, or related healthcare administration. • Proficient in spoken and written English. • Hands-on experience with CAQH ProView, NPPES, PECOS, Availity, state Medicaid systems, or commercial payer portals. • Familiarity with initial credentialing, recredentialing, roster management, provider demographic changes, and payer effective-date verification. • Experience supporting payer contracting, fee-schedule review, contract routing, amendments, or network-development workflows is strongly preferred. • Behavioral health, telehealth, or multi-state provider-network experience is a plus. • CPCS or another credentialing certification is a plus, but not required. • Exceptional attention to detail when identifying inconsistencies across names, addresses, licenses, NPIs, TINs, taxonomy codes, and effective dates. • Ability to manage multiple applications, contracts, deadlines, and payer conversations. • Persistent, professional follow-up with payers and resolution of delayed or incomplete applications. • Ability to identify risks and escalate issues proactively. • Ability to adapt to new payer requirements, systems, and evolving processes. • Ability to maintain clear documentation with an owner, status, next step, and follow-up date for every open item. • Trustworthiness with sensitive information and discipline around authorization, attestations, signatures, and access controls. • Work availability from 8:00 AM to 5:30 PM Central Time.

🏖️ Benefits

• Fully Remote work setup