Sobre esta vaga de Credentialing and Enrollment Coordinator na Foodsmart
The Credentialing and Enrollment Coordinator will work closely with the Credentialing and Enrollment Team, Clinical Operations department, and clinical staff to uphold the standards of professional practice and regulatory compliance such as CMS, NCQA, PECOS, with a primary focus on supporting the credentialing and enrollment of registered dietitians and other healthcare providers.
This position offers an opportunity to gain a higher level of experience in healthcare administration while supporting the credentialing and enrollment processes. The ideal candidate will be detail-oriented, eager to learn, and possess strong organizational skills to assist in maintaining the quality of healthcare services.
You Will:
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Collect, verify, and maintain provider credentials, including education, licensure, board certification, DEA registration, malpractice insurance, and work history
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Conduct primary source verification (PSV) of licenses, certifications, and education through official sources
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Support compliance efforts with regulatory and accrediting institutions
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Maintain and update provider profiles in CAQH (Council for Affordable Quality Healthcare) through the Group Profile
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Track credential expiration dates and proactively initiate renewals for licenses, CDRs, DEA registrations, board certifications, and malpractice coverage, as applicable
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Prepare providers for credentialing committee review and respond to requests for additional information
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Conduct/review background checks, National Practitioner Data Bank (NPDB) queries, and OIG/SAM exclusion list checks, etc.
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Maintain compliance with NCQA, CMS, or state-specific credentialing standards
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Help manage communication with providers, insurances, and related entities
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Enroll providers with Medicare, Medicaid, and commercial insurance payers
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Complete and submit payer enrollment applications
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Track application status and follow up with payers to resolve delays or denials
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Link providers to group practices and tax ID numbers with appropriate payers
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Process provider terminations, updates, and re-validations with payers
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Coordinate effective dates of enrollment with billing and revenue cycle teams to avoid claim denials
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Support the interpretation of basic policies and procedures
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Input provider information into credentialing/enrollment databases and systems
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Maintain data accuracy and confidentiality
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Assist in generating basic reports related to credentialing and enrollment
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Help manage communication with providers, insurances, and related entities
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Provide customer service support and help respond to inquiries
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Support provider education efforts on enrollment requirements
You Have:
Minimum of 1 year of experience in Medicare and/or Medicaid enrollment, with foundational knowledge of related processes
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
Proven ability to manage multiple complex projects and consistently meet deadlines
Excellent written and verbal communication skills
Ability to work both independently and collaboratively within a team environment
About our benefits and perks:
✅ Remote-First Company
✅ Unlimited PTO
✅ Flexible & remote location
✅ Healthcare Coverage (Medical, Dental, Vision)
✅ 401k & bonus
✅ Registered Dietitian Sessions
Foodsmart is an Equal Opportunity Employer. It is our firm policy to extend equal employment and advancement opportunity to all applicants and employees without regard to race, color, national origin, citizenship status, religious creed, age, sex (including pregnancy, childbirth, breastfeeding, medical conditions related to pregnancy, childbirth and/or breastfeeding), gender, gender identity and expression, sexual orientation, marital status, disability (physical or mental) and/or a medical condition, genetic information, ancestry, veteran status or service in the uniformed services, and any other characteristic protected by applicable federal, state or local law.
