Key Facts

Remote From:

Full time

Expert & Leadership (>10 years)

English

Hard Skills

Revenue Management Credential Manager Escalation Management Exception Reporting Enrollment Management Medicaid Waiver Patient Onboarding Credential Manager Escalation Management Stakeholder Communications

Other Skills

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Communication
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Time Management
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Teamwork
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Organizational Skills
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Detail Oriented
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Prioritization
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Problem Solving

Roles & Responsibilities

Minimum of 2 years of successful work experience in physician credentialing and/or physician enrollment
Experience with provider credentialing databases/websites/portals (CAQH, NPPES, PECOS)
Experience with Modio software preferred
Working knowledge of the revenue cycle process

Requirements:

Serve as primary liaison with Clinician Onboarding Liaison (COL) and recruiting during onboarding; provide weekly credentialing updates on payor enrollment status
Obtain, maintain, and timely submit provider credentialing documents for new and existing providers; prepare and track applications; escalate issues to the Director as needed
Manage credentialing databases/websites/portals (CAQH, NPPES, PECOS); generate/update credentialing reports and ensure timely payer enrollment and active status; prepare re-credentialing paperwork
Collaborate with Director and stakeholders on onboarding new facilities and providers across markets; communicate challenges and keep stakeholders informed; meet with health plans to obtain statuses and address claims issues

Job description

Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder. Crossroads is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery. This comprehensive approach to treatment, the gold standard in care for opioid use disorder, has been shown to prevent more deaths from overdose and lead to long-term recovery. We are committed to bringing critical services to communities across the U.S. to improve access to treatment for over 26,500 patients. Our clinics are all outpatient and office-based, with clinics in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania, Tennessee, Texas, and Virginia. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients.

Day in the Life of a Provider Enrollment Coordinator

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.
Research 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.

Education and Experience requirements:

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).
Experience with Modio software preferred.
Working knowledge of the revenue cycle process.
Overtime may be required by Management.

Schedule

Expected hours for this role are 37-40 hours per week. See specific schedule requirements below.

8:00am-5:00pm

Position Benefits

Have a daily impact on many lives.
Excellent training if you are new to this field.
Mileage reimbursement (if applicable) Crossroads matches the current IRS mileage reimbursement rate.
Opportunity to save lives every day!