Credentialing, Privileging and Payer Enrollment Coordinator

Credentialing, Privileging and Payer Enrollment Coordinator

The Coordinator of Provider Credentialing, Privileging & Payer Enrollment is responsible for the oversight, coordination, and execution of all credentialing, re-credentialing, privileging, payer enrollment, and related compliance activities for the organization.

This role serves as the organizational subject matter expert (SME) for complex federal, state, Medicaid Managed Care, Medicare, and commercial payer requirements. The Coordinator ensures compliance with HRSA, FQHC, state, and payer regulations while protecting uninterrupted provider participation and revenue integrity.

The Coordinator works collaboratively with Finance, Revenue Cycle, Compliance, Clinical Leadership, Human Resources and external payer representatives to manage regulatory risk and support organizational growth.

The Benefits of Fairfield Community Health Center

• Medical, Dental and Vision Insurance
• Disability Insurance
• 401 (k)
• 4% 401(k) Match
• PTO Accrual
• 11 yearly paid holidays
• Education assistance
• Tuition Reimbursement
• Hands-on training

Essential Duties and Responsibilities:

1. FQHC Credentialing & Privileging Oversight

· Manage the full lifecycle of provider credentialing, re-credentialing, and privileging in accordance with FQHC, HRSA, state, and accreditation standards.

· Administer formal privileging processes, including initial appointment, reappointment, scope of service review, and required Board documentation.

· Manage credentialing and re-credentialing processes including attestations for service providers.

· Ensure primary source verification of licensure, DEA registration, board certification, education, training, work history, OIG/GSA exclusion checks, and other regulatory requirements.

· Obtain and review provider documentation to determine licensing status and eligibility.

· Maintain audit-ready credentialing files and documentation.

2. Payer Enrollment & Complex Regulatory Management

· Oversee processing of enrollment and revalidation requests with Ohio Department of Medicaid, Medicare, Managed Care Organizations, and commercial insurance providers.

· Ensure timely submission and follow-up of provider and group enrollments, amendments, demographic updates, and revalidation requirements.

· Maintain and attest CAQH profiles and ensure NPI and payer directory accuracy.

· Serve as escalation point for complex payer requirements, denied enrollments, retroactive effective date requests, and regulatory interpretation.

· Oversee commercial insurance contracting processes including interest forms, applications, and fee schedule review.

· Monitor Ohio Managed Care initiatives and regulatory updates to proactively identify payer changes, billing opportunities, and compliance risks.

· Collaborate with Revenue Cycle to resolve mapping issues, failed claims, EOB discrepancies, and clearinghouse rejections related to credentialing or enrollment.

3. Organizational Leadership & Collaboration

· Provide structured guidance and workflow coordination for credentialing and enrollment processes across departments to ensure complete and timely certification/re-certifications.

· Serve as internal subject matter expert on credentialing, privileging, and payer enrollment requirements.

· Participate in recruitment activities related to provider onboarding by ensuring timely credentialing and enrollment initiation.

· Develop and maintain standardized workflows, tracking tools, and internal controls.

· Prepare reports for Finance and Revenue Cycle leadership regarding enrollment status, recredentialing cycles, and compliance deadlines.

· May assume supervisory responsibilities if the credentialing function expands in the future.

4. Systems & Data Integrity Oversight

· Ensure accurate entry and maintenance of provider information within the Electronic Health Record (EHR) and payer systems.

· Maintain tracking systems for credentialing expirations, attestations, enrollment deadlines, and revalidation schedules.

· Ensure internal controls are in place to prevent lapses in credentialing or payer participation.

· Delegate and respond to provider, Medicaid, and insurance inquiries related to credentialing and enrollment.

5. Policy & Compliance

· Develop, implement, and maintain credentialing, privileging, and payer enrollment policies and procedures.

· Ensure alignment with HRSA Compliance Manual requirements, FQHC standards, and state and federal regulations.

· Maintain documentation necessary for HRSA Operational Site Visits, payer audits, and internal compliance reviews.

· Participate in strategic projects as requested by the Director of Finance and Revenue Cycle Director.

Competencies/Skills:

• Ability to work independently as well as in a team environment.
• Ability to prioritize, multi-task and manage time effectively.
• Basic usage of Excel and Word.
• Quality focus, strong organization, and attention to detail.
• Demonstrates dependability through good attendance and punctuality.
• Willingness to learn, embrace change and maintain a positive attitude.

Minimum Qualifications:

· Bachelor’s degree in Business, Healthcare Administration, Public Health, or related field preferred. Minimum of six (6) years of progressively responsible experience in credentialing, privileging, and payer enrollment required.

· Minimum 4 years of credentialing experience; primary care experience required, FQHC experience and behavioral healthcare experience strongly preferred.

· Minimum 6 years of Medicaid billing and reimbursement experience; Ohio Behavioral Health experience preferred.

· Minimum 6 years of experience using an Electronic Health Record (EHR) to manage providers and claims.

· Demonstrated expert knowledge of credentialing, privileging, payer enrollment processes, and compliance standards.

· Strong understanding of FQHC regulatory requirements and managed care structures.

· Ability to manage multiple complex projects and deadlines independently.

· Strong verbal and written communication skills.

· Exceptional attention to detail and organizational skills.

PHYSICAL REQUIREMENTS:
Sedentary work that primarily involves sitting/standing.

About Fairfield Community Health Center

We are a 501(c)(3) non-profit organization, working to improve the overall health and wellness of our community. Our purpose is to make sure everyone has access to quality, affordable healthcare, regardless of insurance or income status.

Our integrated approach to your care gives us a complete look at all aspects of your health in order to determine the best health plan to fit your unique needs. Our mission is "To Strengthen the Community by Caring for You."

For more about us, visit our website at https://www.fchc.org

Job Type: Full-time

Pay: $17.79 - $25.57 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Tuition reimbursement
• Vision insurance

Education:

• Bachelor's (Preferred)

Experience:

• FQHC : 4 years (Preferred)
• Credentialing and Privileging, Payer Enrollment : 6 years (Required)

Work Location: Hybrid remote in Lancaster, OH 43130

Salary : $18 - $26