Payor Credentialing Coordinator Palliative

Job Summary:

Responsible for managing all aspects of payer enrollment and credentialing for healthcare providers. This role ensures timely application submission, accurate provider data maintenance, and compliance with all federal, state, and payer-specific requirements to support uninterrupted patient care delivery.

Job Responsibilities:

• Prepare and submit credentialing and re-credentialing applications for healthcare providers.
• Track application status and proactively manage approval timelines.
• Maintain accurate and up-to-date provider files and credentialing records.
• Enroll providers with Medicare, Medicaid, and commercial insurance payers.
• Manage CAQH profiles and NPPES updates.
• Collect and verify provider documentation (licenses, certifications, malpractice insurance, etc.).
• Ensure compliance with federal, state, and payer-specific requirements.
• Liaise between providers, insurance companies, and internal departments (billing, HR, etc.).
• Respond to payer inquiries and resolve credentialing delays or issues.
• Participate in status meetings and manage credentialing pipelines based on priority and deadlines.
• Maintain strict confidentiality of sensitive information.
• Adhere to organizational policies, procedures, and compliance standards.
• Perform additional duties as assigned.

Strategic Acumen:

• Understands the impact of credentialing timelines on patient care and revenue cycle performance.
• Aligns work priorities with organizational goals and operational need.

Financial Stewardship:

• Supports revenue integrity by ensuring timely payer enrollment and minimizing delays in billing readiness.

Influence & Diplomacy:

• Builds effective working relationships with providers, payers, and internal stakeholders.
• Communicates clearly to resolve issues and drive outcomes.

Data Literacy:

• Utilizes tracking systems and reporting tools to monitor credentialing progress and compliance.
• Maintains accurate documentation and data integrity.

Working Conditions:

• Fast-paced office environment.
• Some stress may occur, particularly with deadlines and payer requirements.

Physical Demands:

• Prolonged periods of sitting and computer use.
• Frequent communication via phone and electronic systems.
• Occasional lifting of up to 10 pounds.
• Visual acuity for detailed data entry and review.

Standards:

• Maintains high standards of integrity and business ethics.
• Abides by company rules, policies and procedures, and applicable laws and regulations.
• Conducts self in an honest, ethical manner.
• Reports promptly any suspected violation of compliance standards via the open-door policy.

Directions Received:

Reports to the Care Transitions Manager.

Required Skills & Experience:

• Strong data processing and attention to detail.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet deadlines.
• Strong analytical and problem-solving capabilities.
• Ability to handle confidential information with discretion.
• High level of organization and accuracy.
• Customer service orientation with strong interpersonal skills.
• Proficiency in Microsoft Excel and standard Microsoft Office applications.
• Experience with credentialing platforms (e.g., CAQH, NPPES).
• Familiarity with internal tracking and HR/billing systems.
• One to three years of experience in credentialing, billing, or healthcare administration.
• Experience managing time-sensitive information from multiple sources.
• Strong administrative and data entry experience.

Schedule Notes:

Monday to Friday, 9 a.m. to 5 p.m., with a hybrid schedule: Monday and Friday from home and Tuesday through Thursday in-office. Local candidates preferred. Must have three years of relevant experience and be a self-starter able to ramp up quickly to support the team.