Credentialing & Payer Contracting Coordinator
3 нед. назад
MiddleRemote
Coordinating provider credentialing, payer enrollment, and contracting workflows for mental health clinicians.
Обязанности
- We’re looking for a highly organized, detail-oriented Credentialing & Payer Contracting Coordinator to help clinicians move efficiently from onboarding to payer participation and billing readiness.
- You’ll coordinate provider credentialing, recredentialing, payer enrollment, and contracting workflows across commercial and government health plans. You’ll collect and maintain provider information, submit applications, follow up with payers, track agreements and effective dates, and ensure every open item reaches a clear resolution.
- We’re a fast-paced startup, so the right person is proactive, persistent, adaptable, and energized by building better processes as we scale. This is a non-clinical and non-legal role. You will not provide clinical or legal advice, sign agreements, negotiate outside approved parameters, or attest on behalf of a provider without documented authorization.
- Coordinate initial credentialing, payer enrollment, and recredentialing for new and existing clinicians.
- Collect, review, and organize provider documentation, including licenses, DEA registrations where applicable, malpractice coverage, CVs, education and work history, board certifications, W-9s, NPIs, taxonomy codes, disclosures, and attestations.
- Maintain accurate provider profiles in CAQH ProView, NPPES, PECOS, state Medicaid systems, commercial payer portals, and internal tracking systems.
- Prepare, submit, and track enrollment applications, roster additions, demographic changes, service-location updates, reassignment requests, terminations, and payer requests for additional information.
- Follow up consistently with payer representatives through phone, email, portals, and ticketing systems; document every interaction and escalate stalled or time-sensitive applications.
- Support the payer-contracting lifecycle, including network-interest submissions, contracting applications, agreement intake, fee-schedule organization, redline tracking, signature routing, amendments, and renewals.
- Route reimbursement, legal, and operational terms to the appropriate internal decision-makers for review and approval.
- Maintain a reliable source of truth for each provider and payer, including application status, participating plans, contract status, effective dates, rates, renewal dates, outstanding items, owners, and next follow-up dates.
- Coordinate with provider operations, revenue cycle, finance, legal, and billing teams to confirm that credentialing, contracting, roster loading, and billing setup are complete before a provider is marked ready to bill.
- Monitor licenses, attestations, recredentialing deadlines, contract renewals, and other expirations to prevent avoidable interruptions in payer participation.
- Investigate discrepancies across provider records, payer portals, contracts, directories, and internal systems, and drive each issue through verified resolution.
- Track turnaround times, aging applications, upcoming deadlines, payer bottlenecks, and operational risks through clear weekly reporting.
- Identify recurring issues and improve workflows through better templates, checklists, documentation, automation, and escalation paths.
- Protect provider information and any patient information encountered by following Legion’s privacy, security, and access-control requirements.
Условия
- Hourly Compensation: $5–$15 per hour
- Work Setup: Fully Remote
Другое
- At Legion Health, we believe everyone deserves fast, affordable, and effective mental health care—and we’re on a mission to deliver it at scale.
- Legion Health is a full-stack, AI-native psychiatry network. Our clinicians provide care directly to patients while AI agents automate key care operations, including scheduling, risk analysis, billing, and administrative coordination.
- Join us as we build the future of mental health—and a better experience for patients and clinicians, powered by both humans and AI.
- Job Type: Contract
- Role Type: Credentialing & Payer Contracting Operations
- Ideal Experience Level: 2+ years
- Location: Fully Remote
- Work Hours: 8:00 AM–5:30 PM Central Time
- Proficient in spoken and written English.
- Exceptionally detail-oriented and able to identify inconsistencies across names, addresses, licenses, NPIs, TINs, taxonomy codes, and effective dates.
- Organized and comfortable managing multiple applications, contracts, deadlines, and payer conversations without losing track of details.
- Persistent and professional when following up with payers and resolving delayed or incomplete applications.
- Proactive about identifying risks and escalating issues before they affect provider launches, network participation, or billing.
- A quick learner who can adapt to new payer requirements, systems, and internal processes.
- Comfortable working in a fast-paced startup where processes are continuously evolving.
- Skilled at maintaining clear documentation and ensuring every open item has an owner, status, next step, and follow-up date.
- Trustworthy with sensitive information and disciplined about authorization, attestations, signatures, and access controls.
- 2+ years of experience in provider credentialing, payer enrollment, contract administration, provider operations, medical-staff services, revenue-cycle operations, or related healthcare administration.
- Hands-on experience with CAQH ProView, NPPES, PECOS, Availity, state Medicaid systems, or commercial payer portals.
- Familiarity with initial credentialing, recredentialing, roster management, provider demographic changes, and payer effective-date verification.
- Experience supporting payer contracting, fee-schedule review, contract routing, amendments, or network-development workflows is strongly preferred.
- Behavioral health, telehealth, or multi-state provider-network experience is a plus.
- CPCS or another credentialing certification is a plus, but not required.
- The most important qualifications are operational ownership, accuracy, persistent follow-through, and clear communication.