Credentialing and Enrollment Coordinator
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Job Description
Credentialing and Enrollment Coordinator supporting Foodsmart’s telenutrition platform. Verifying provider credentials and enrolling healthcare providers with Medicare, Medicaid, and commercial payers.
Responsibilities:
- 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
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