Credentialing Coordinator, FT, Days
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Job Description
Credentialing Coordinator managing provider credentialing, payer enrollment, and compliance for Connections Health Solutions’ behavioral health crisis-care operations. Fully remote across eligible U.S. states.
Responsibilities:
- Manage the end-to-end credentialing, re-credentialing, and payer enrollment process for behavioral health providers, behavioral health support staff, and facilities
- Manage new provider onboarding from HR/Talent Acquisition notification through completion of the Medallion profile
- Enter and maintain provider information including NPI, licensure, practice locations, and payer information
- Request required documentation including CAQH, PECOS, state licenses, DEA registrations, board certifications, diplomas, and other credentials; track completion
- Communicate with physicians and providers by phone, text, and email to explain requirements, resolve outstanding items, and answer questions
- Research and interpret state licensing, supervision, collaborative agreement, and scope-of-practice requirements
- Complete primary source verifications including NPI, NPDB, Medicare/Medicaid opt-out, state licensure, DEA, OIG, and SAM checks
- Escalate adverse findings through the credentialing committee review process
- Coordinate malpractice policy additions and upload insurance documentation to the credentialing platform and CAQH
- Manage commercial and government payer enrollment applications, effective dates, payer IDs, and recredentialing dates
- Maintain and re-attest provider CAQH profiles
- Support cross-state licensure and payer enrollment for telehealth providers
- Facilitate state and program-specific registrations, Medicaid portal enrollment, domain transfers, surrogacy requests, and Medicare enrollment through CMS/PECOS
- Manage NPI acquisition and state Medicaid enrollment for behavioral health support staff; distribute compliance reports
- Manage facility-level enrollment and maintenance in state Medicaid systems
- Process provider and BHS staff terminations and notify applicable payers
- Monitor OIG/SAM and NPDB databases, license renewals, board certifications, and recredentialing cycles
- Complete credentialing documentation under delegated credentialing requirements
- Partner with HR, Talent Acquisition, Medical Leadership, and operational leadership
- Participate in quarterly Credentialing Committee meetings and prepare regular status reporting
- Support standardized credentialing workflows, reference guides, process documentation, and SOPs
- Perform other duties and responsibilities as assigned
Requirements:
- High school diploma or equivalent required
- 2 years of experience in provider and/or facility credentialing, payer enrollment, or related managed care administrative work
- General knowledge of regulatory requirements related to credentialing and payer enrollment, including Medicare, Medicaid, and managed care processes and rules
- Ability to research and interpret state licensing board requirements across MD, DO, NP, and PA provider types
- Experience working within a credentialing software platform such as Medallion or a comparable credentialing management system
- Working knowledge of PECOS, CAQH, and state Medicaid provider portals
- Strong customer service orientation and soft skills, with comfort communicating by phone, text, and email with physicians and providers
- Advanced user of Microsoft Office products, particularly Excel
- Must be fully vaccinated with documentation, or exempt through the company exemption process, prior to start date
- Preferred: Bachelor's degree in health care administration or a related field
- Preferred: 3+ years of credentialing or payer enrollment experience within a behavioral health environment
- Preferred: Familiarity with CAQH attestation processes and delegated credentialing requirements
- Preferred: Experience supporting multi-market or multi-state credentialing and enrollment operations
Benefits:
- Employees (and their families) are offered comprehensive health insurance, including Medical, Dental, Vision, Accident, Critical Illness, and Hospital Indemnity
- CHS pays for Basic Life, AD&D, Short and Long-Term Disability
- Voluntary Life insurance option for employees and their families
- Health Savings Accounts with $1,000 to $2,000 employer contribution depending on plan
- Flexible Spending Accounts for health care and dependent care
- 401k company match after 6 months (50% of deferrals up to 6% of compensation)
- Generous PTO starting at 160 hours accrued annually
- 12 recognized company holidays
- Company-paid parental leave available to eligible employees
- Employee Assistance Program providing confidential emotional support, work life solutions, financial solutions, legal assistance, and online support
- After 90 days, auto-enrollment in the 401k Plan
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