Credentialing Coordinator

We're on the hunt for a proactive and assertive individual to support the day-to-day credentialing escapades for our clinical providers, including Primary Care Providers, Specialists, and Ancillary Providers. If you're someone who takes initiative, learns at lightning speed, and follows instructions with ninja-like precision, then this is the role for you!

• Become a master of our Credentialing Policy and Procedures, Departmental Guidelines, and Company Policy.
• Race against the clock to process and complete applications within established timelines.
• Embark on a multi-state journey processing and submitting Medicaid initial enrollment, revalidation, and re-credentialing applications in states like NY, TX, OH, PA, MA, NE, and NJ, all while staying in tune with state-specific requirements.
• Navigate the labyrinth of state Medicaid portals and systems (e.g., NYS Medicaid, TMHP, MITS, PROMISeTM, MA MMIS, NJ MMIS) to ensure provider records are accurate and complete.
• Keep a vigilant eye on application statuses, follow up on outstanding actions, and respond promptly to requests for additional information or corrections.
• Be the guardian of state-specific revalidation cycles and deadlines to prevent lapses, denials, or terminations in Medicaid participation.
• Collaborate with internal teams such as Office Administrators and Revenue Cycle Management (RCM) to solve Medicaid enrollment mysteries impacting claims and reimbursement.
• Work directly with providers and practice staff to gather, verify, and maintain essential documentation, including licenses, DEA, board certifications, practice locations, and ownership disclosures.
• Identify, troubleshoot, and escalate complex or delayed Medicaid enrollment issues, including system errors, site visits, or compliance flags.
• Maintain precise credentialing logs, trackers, and documentation to support audits and reporting requirements.
• Ensure all Medicaid credentialing activities adhere to federal, state, and organizational compliance standards.
• Embrace the unexpected by completing other tasks or projects assigned.
• Be the superhero back-up for other Credentialing staff when needed.