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Credentialing and Provider Enrollment Coordinator
Ascension Executive RecruitmentCredentialing and Provider Enrollment Coordinator supporting Ascension’s nonprofit Catholic health system. Managing provider credentialing, payer enrollment, audits, rosters, and regulatory documentation remotely.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in credentialing and re-credentialing processes, ensuring compliance with managed care criteria and NCQA guidelines. Proficient in processing provider data and conducting audits while staying informed on regulatory and legislative changes.
Highest-signal resume keywords
Credentialing ExperienceManaged Care KnowledgeNCQA Guidelines ComplianceMD Staff ProficiencyCAQH Application Submission
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CredentialingRe-CredentialingState-Specific Credentialing VerificationsProvider Data ProcessingAudit AssistanceRegulatory Monitoring
Tools & Technologies
MD Staff
Certifications & Qualifications
Professional Licensure/Certification
Industry Keywords
Managed Care CriteriaPayer RequirementsDelegated CredentialingHealth Plan ExperienceRegulatory Compliance
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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