Senior Payer & Credentialing Coordinator

Position Summary

The Senior Payer & Credentialing Coordinator is responsible for managing provider enrollment and credentialing activities for multiple healthcare clients. This role oversees credentialing with Manage provider enrollment and credentialing with government and commercial payers, ensuring providers are enrolled, revalidated, and maintained in accordance with payer requirements. The Senior Coordinator independently manages a portfolio of clients with varying service levels, from Medicare/Medicaid enrollment only to full payer credentialing.

Essential Responsibilities

• Manage provider enrollment, credentialing, recredentialing, and revalidation with government and commercial payers.
• Complete provider enrollments, demographic updates, practice changes, reactivations, and ownership changes as needed.
• Maintain accurate provider records in CAQH, PECOS, NPPES, state Medicaid portals, and payer enrollment systems.
• Monitor application status, follow up with payers, and resolve enrollment issues to ensure timely approvals.
• Track credentialing deadlines, license and certification expirations, and payer revalidation requirements.
• Serve as the primary credentialing contact for assigned clients and provide regular status updates.
• Maintain organized credentialing documentation and ensure compliance with payer and regulatory requirements.
• Identify and implement process improvements to increase efficiency and accuracy.
• Assist with training and mentoring less experienced credentialing staff.

Qualifications

• 5 years of provider enrollment and credentialing experience preferred.
• Extensive knowledge of Medicare, Medicaid, CAQH, PECOS, NPPES, and commercial payer credentialing processes.
• Experience managing multiple providers and clients simultaneously.
• Strong organizational, analytical, and communication skills.
• Proficiency in Microsoft Office applications, particularly Excel.
• High school diploma required; Associate's or Bachelor's degree preferred.

Preferred Qualifications

• CPCS or CPMSM certification preferred.
• Experience supporting multi-specialty physician practices.
• Familiarity with credentialing software and payer enrollment portals.