Responsible for coordinating and maintaining timely, accurate provider credentialing, recredentialing, and payer enrollment activities for physicians, advanced practice providers, and other applicable providers.
Serves as a primary liaison among providers, organizational departments, and third-party payers to ensure providers are appropriately credentialed and enrolled and that provider information remains current. Works closely with Human Resources, Medical Staff/Credentialing partners, Revenue Cycle, Finance, and clinical departments to support timely provider onboarding and prevent enrollment-related disruptions to billing and reimbursement.
Key responsibilities include maintaining provider enrollment records, tracking applications from submission through approval, updating CAQH profiles, coordinating Medicare/Medicaid/commercial enrollment and revalidation, reconciling payer rosters, resolving enrollment discrepancies, supporting payer audits, maintaining organized credentialing records, developing workflows, and assisting with payer contracting administrative tasks.
Associate degree in Business, Healthcare Administration, or a related field preferred; equivalent relevant experience may substitute for education.
- Two or more years of healthcare credentialing, provider enrollment, medical practice administration, or revenue cycle experience preferred
- Experience with commercial payers, Medicare, and Medicaid enrollment strongly preferred
- Experience with CAQH and electronic payer enrollment systems preferred
- Knowledge of physician and advanced practice provider credentialing requirements
- CPCS or related credentialing certification preferred but not required
Location
Michigan, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago