Credentialing and Enrollment Coordinator Details

Credentialing and Enrollment Coordinator

Crossroads Treatment Centers - Greenville, SC

Employment Type : Full-Time

Crossroads Treatment Centers was founded on May 5, 2005 to serve a patient population with opioid addiction. Since its founding in 2005, the company has grown rapidly and now includes 110+ treatment centers in 10 states. Each member of the Crossroads team specializes in an area that supports the recovery of over 26,000 patients. Crossroads' clinical staff includes physicians, pharmacists, counselors, nurses, and other service coordinators. Along with medication management, our staff works closely with each patient to create an individualized treatment plan aimed at building recovery and relapse prevention skills.

This role will be based in our Greenville, SC Corporate office and had remote flexibility.

General Responsibilities:

The Enrollment Coordinator is responsible for credentialing, enrollment and recovery process pertaining to the credentialing process at Crossroads. This includes coordinating with our third-party credentialing vendor and/or in our credentialing database and the management of our providers in the credentialing process. This role receives all documentation and notifications that a provider needs to be credentialed and enrolled, identifies payor and facility requirements, and generates required applications. This position is responsible for all credentialing management, expirables maintenance, payer research, application generation preparation, processing and presentation.

This role can be fully remote.

Primary Responsibilities include:

• Receives notifications from the Clinician Onboarding Liaison (COL)
• Work closely with recruiting team during the onboarding process of new providers and provide weekly credentialing updates as to status of enrollment with payors.
• Obtain and maintain provider credentialing documents for new and existing providers, including expiring documentation
• Provides timely and pertinent information on providers for Credentialing Committee review and approval
• Escalates Provider Credentialing issues to the Director, as needed
• Escalates payor issues to Director, as needed.
• Tracks, generates, and prepares applications to send to provider.
• Conducts payer research on the provider
• Adds providers to the Credentialing report
• Reviews returned packets for accuracy and communicates updates to the Providers
• Review weekly exception reports from management to prioritize critical issues
• Follows up with providers for un-returned paperwork
• Sends updated credentials to the payer and complete payer credentialing applications for new facility locations in multiple states
• Researches state requirements prior to entry into the state and creates SOP regarding same.
• Works with Director and other key stakeholders on all new facilities including enrollment of facilities and individual locations into new markets.
• Keeps all key stakeholders informed of any challenges faced in new markets.
• Primary point of contact for withdrawal of provider's employment; receive and update and notify others, if needed
• Generate correct payer paperwork for re-validations/begin re-credentialing process
• Partner with COL, credentialing coordinators and other key stake holders in onboarding and enrollment providers and facilities with Medicaid, Medicare, commercial and managed care plans.
• Maintenance of provider enrollment processes and credentialing databases/websites/portals including CAQH, NPPES, Navinet, Availity, PECOS.
• Support overall Provider Enrollment Department, assist contracting department with requests as necessary and work with RCM to assist with payer issues related to credentialing
• Meets at least monthly with health plans (more if needed) to obtain statuses of providers and to address any claims issues including holds and denials.
• Works with payors to ensure timely enrollment & active status.
• Escalates trends and issues to RCM, operations, and other key stake holders as needed.

Required Skills and Qualifications:

• Minimum of 2 years of successful work experience in physician credentialing and/or physician enrollment.
• Experience with provider credentialing databases/websites/portals (i.e.- CAQH, NPPES and PECOS)
• Proficiency in the use of Microsoft Office applications; Excel, Word and Outlook.
• Self-starter with strong organizational skills and a sense of urgency
• Ability to work independently and as part of a team
• Timely follow-up on open items
• Excellent verbal and written communication skills
• Working knowledge of the revenue cycle process
• Meticulous accuracy
• Proven ability to support multiple projects and work in stressful situations
• Good decision-making and problem-solving skills
• Overtime may be required by Management

Language Skills: Ability to read, analyze, and interpret human service periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee occasionally lifts/carries paperwork, files, office supplies, up to 20 lbs., pushes/pulls exerting up to 5-10 lbs. force, opening doors, file drawers, pushing files in drawers, and kneeling/crouching and/or ability to reach lower file drawers, file stretching to store of retrieve materials. Specific vision abilities required by this job include close vision and the ability to adjust focus. Frequent sitting at desk or computer while typing, completing paperwork, or meeting with patients.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.