Lead, Provider Enrollment Coordinator

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We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Lead, Provider Enrollment Coordinator is responsible managing/overseeing ChenMed’s third-party provider enrollment partner to ensure accurate and timely provider enrollment submissions of our new providers with market payers as well as, ensuring that recredentialing is processed in a timely fashion. The incumbent in this role is also responsible for assessing and providing continuous improvement recommendations to the provider enrollment process, co-facilitating improvement design sessions in coordination with Talent Acquisition, HR Services and Systems, Network and Operations team members and training respective departments on processes and guidelines. He/She serves as the primary point of contact for resolving market questions and issues related to providers' credential status.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Leads weekly calls with provider enrollment third party partner to ensure enrollment and recredentialing is being processed in a timely fashion.
• Coordinates and monitors credentialing activities processed by provider enrollment partner to ensure timely processing of provider payor and facility applications, including supporting the collection of any required documents from providers, as needed.
• Manages the acquisition of professional state licenses through ChenMed’s third-party provider enrollment partner.
• Conducts monthly payer rosters validations to ensure accurate primary practice locations, panel status and directory visibility with health plans and Provider Enrollment vendor, ensuring alignment.
• Provides credentialing status updates to markets on new providers.
• Maintains current credentialing requirements and point of contact with each payor.
• Supports Credentialing Manager with new market projects
• Fields and resolve credentialing related questions and issues from markets.
• Identifies process improvement opportunities and presents recommendations to Credentialing Manager and other leadership stakeholders.
• Identifies issues that require additional investigation and evaluation, validates discrepancies with provider payor participation statuses and ensures appropriate follow up.
• Implements improvement opportunities by creating or updating documentation and training resources.
• Serves as the primary point of contact to work with Legal, Risk, Compliance and Billing departments to ensure seamless submission of enrollment and recredentialing occurs.
• Serves as the primary point of contact for PCP recruiters on providing clinical ready effective dates for incoming providers.
• Compiles and maintains current and accurate credentials information for all providers using Workday
• Obtains provider information for web-based applications and credentialing databases such as PECOS and CAQH during initial new hire/onboarding of clinicians.
• Obtains professional liability insurance for provider and forwards to Provider Enrollment vendor.
• Completes provider applications for expiring provider credentials to maintain active credentials necessary to maintain enrollment with payors (DEA, State Licensure, National Board Certification, and CDS as applicable).

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of Medicare, Medicaid, and Commercial Payer Provider Enrollment rules, regulations and guidelines
• Knowledge of credentialing requirements such as those outlined NCQA, AAAHC and / or URAC
• Knowledge and understanding of the credentialing process
• Ability to effectively communicate, both verbally and in writing, with team members, supervisors, providers, clinicians and insurance contacts
• Ability to maintain complete confidentiality in handling sensitive enrollment issues.
• Professional, motivated and pleasant demeanor
• Excellent organizational, interpersonal and follow-up skills with attention to detail and accuracy
• Informational research skills
• Strong problem-solving skills are essential. Database management skills including querying, reporting, and document generation
• Ability to organize and prioritize work and manage multiple priorities simultaneously to meet deadlines
• Ability to work independently with minimal supervision
• Ability to establish and maintain effective working relationships with external vendors/contacts and internal stakeholders including providers, management, staff
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
• Ability and willingness to travel locally, regionally and nationwide up to 10% of the time
• Spoken and written fluency in English

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of Medicare, Medicaid, and Commercial Payer Provider Enrollment rules, regulations and guidelines
• Knowledge of credentialing requirements such as those outlined NCQA, AAAHC and / or URAC
• Knowledge and understanding of the credentialing process
• Ability to effectively communicate, both verbally and in writing, with team members, supervisors, providers, clinicians and insurance contacts
• Ability to maintain complete confidentiality in handling sensitive enrollment issues.
• Professional, motivated and pleasant demeanor
• Excellent organizational, interpersonal and follow-up skills with attention to detail and accuracy
• Informational research skills
• Strong problem-solving skills are essential. Database management skills including querying, reporting, and document generation
• Ability to organize and prioritize work and manage multiple priorities simultaneously to meet deadlines
• Ability to work independently with minimal supervision
• Ability to establish and maintain effective working relationships with external vendors/contacts and internal stakeholders including providers, management, staff
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
• Ability and willingness to travel locally, regionally and nationwide up to 10% of the time
• Spoken and written fluency in English

EDUCATION AND EXPERIENCE CRITERIA:

• BA/BS degree in Healthcare Administration, Business Administration or a related field OR additional experience above the minimum will be considered in lieu of the required education on a year-for-year basis required
• A minimum of 5 years work experience as a Credentialing/Physician Enrollment Coordinator or a similar role required
• A minimum of 1 year of Medical/Payor Credentialing and/or hospital privileging experience required

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