Practitioner Mgmt Coord (US)
Cerritos, CA - USA
Job Summary
Job Description Summary
The Credentialing & Enrollment Specialist is responsible for coordinating and maintaining provider credentialing and enrollment activities to ensure compliance with organizational regulatory and health plan requirements. This role manages initial credentialing and recredentialing inventories supports provider enrollment processes conducts outreach for missing documentation communicates credentialing decisions and serves as a liaison between providers network partners and internal stakeholders. The position requires strong organizational skills attention to detail proficiency in Microsoft Excel and excellent written and verbal communication skills.How will you make an impact & Requirements
- Manage and maintain assigned initial credentialing and recredentialing inventories to ensure timely completion and compliance with established turnaround times.
- Review credentialing and enrollment applications for completeness and accuracy.
- Conduct outreach to providers provider groups and internal stakeholders to obtain missing or required documentation.
- Track and monitor credentialing and enrollment status through various systems and reports.
- Communicate credentialing approvals denials and status updates to providers and internal business partners.
- Support provider enrollment activities with government and commercial payers.
- Maintain accurate provider records files and databases.
- Monitor shared departmental email inboxes and respond to inquiries in a timely and professional manner.
- Collaborate with network partners health plans provider offices delegated entities and internal departments to resolve credentialing and enrollment issues.
- Prepare and maintain Excel spreadsheets tracking logs and reports for operational and audit purposes.
- Ensure compliance with NCQA CMS state regulatory and organizational credentialing requirements.
- Assist with credentialing audits data validation and special projects as assigned.
- Escalate complex issues and aging inventory items as appropriate.
Required Education and Experience
- High school diploma or equivalent required; Associates or Bachelors degree preferred.
- Minimum of 2 years of healthcare credentialing and/or provider enrollment experience.
- Experience working with health plans provider groups or managed care organizations preferred.
- Knowledge of provider credentialing recredentialing and enrollment processes.
Knowledge Skills and Abilities
- Strong proficiency in Microsoft Excel including sorting filtering reporting and data management.
- Excellent verbal and written communication skills.
- Strong attention to detail and organizational skills.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
- Experience maintaining shared mailboxes and managing high-volume communications.
- Ability to work independently and collaboratively with cross-functional teams.
- Customer service oriented with strong problem-solving skills.
- Knowledge of credentialing regulations accreditation standards and provider data management preferred.
- Experience with NCQA credentialing standards.
- Experience with provider enrollment systems CAQH PECOS NPPES Availity and state Medicaid enrollment portals.
- Experience supporting delegated credentialing or managed care network operations.
Compensation Range:
$24.20to
$43.56The anticipated base salary range represents the Companys good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience skills qualifications geographic location internal equity and business needs.
About Company
Millennium Physician Group is one of the largest physician groups with more than 550 healthcare providers in Florida.