Provider Enrollment & Credentialing Coordinator

Reports to : Supervisor of Provider Enrollment & Credentialing

Hybrid : 1 day in office per month

Pay : $24.00 - $26.00 an hour

The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and other job-related reasons.

The Provider Enrollment & Credentialing Coordinator is responsible for all aspects of provider enrollment, credentialing, recredentialing, and privileging processes for employed and contracted practitioners. This includes maintaining accurate provider data in credentialing databases, ensuring timely submission and renewal of required documentation and supporting compliance standards. The Coordinator will work closely with providers, payers, and internal departments to ensure practitioners are appropriately credentialed and enrolled to support timely patient access and reimbursement.

Responsibilities :

• Coordinate initial credentialing and recredentialing for physicians, physician assistants, and advanced practice providers across Medicare, Medicaid, commercial insurers, and delegated payers.
• Obtain and maintain NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites.
• Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications.
• Track and maintain provider insurance participation status and effective dates in Athena.
• Maintain timely and accurate data entry in credentialing databases and payer portals; update provider rosters and profiles as needed.
• Process facility privilege applications and reappointments of privileges.
• Monitor and manage expirable documents (licenses, DEA, board certifications, malpractice insurance), alerting providers and escalating unresolved expirations to the Manager.
• Submit and update provider information in the CAQH ProView system as required by participating health plans.
• Ensure compliance with NCQA, URAC, CMS, and payer requirements for provider credentialing and enrollment.
• Assist with issue resolution and communication with payers regarding credentialing / enrollment status and delays.
• Upload and track CME documentation in relevant databases (e.g., CE Broker).
• Communicate credentialing or enrollment issues and application delays to the Manager in a timely manner.
• Participate in internal audits, special projects, and process improvements as directed.
• Perform other duties as assigned by department leadership.

Education and Experience :

Preferred Qualifications & Skills

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and / or be subject to random drug testing in accordance with applicable laws and company policy.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.