Credentialing Specialist - local candidates only apply

Under the direct supervision of the Vice President of Credentialing, Education & Development, the Credentialing, Enrollment and Education Coordinator is responsible for collecting, documenting, and retaining provider records necessary to support the credentialing and enrollment process of providers with commercial insurance and governmental payers. This role has a high impact on revenue cycle management and operational efficiency as well as timely access to patient care from qualified providers.The Credentialing, Enrollment and Education Coordinator is also responsible for performing administrative tasks to facilitate, track and monitor education and training activities to assist staff maintain competencies, build new skills, and create pathways for professional growth and development.In order to perform the duties of this position, applicants must be able to commute to our office in Milford, MA on a consistent basis. Eligibility for a hybrid work schedule will be assessed after successful completion of probationary period.   DUTIES AND RESPONSIBILITIES:Prepare and process enrollment applications for various health plans, ensuring all necessary documentation is complete and accurate. Maintain accurate databases of provider information, including licensure, certification, professional liability coverage, CAQH profile, enrollment status, changes in provider status, and other relevant data to ensure it is current, accurate and does not expire.Manage the re-enrollment process for providers, ensuring they remain in good standing with insurance plans. Provide timely notifications to providers, insurance companies and stakeholders regarding new providers, resignations, and changes in provider status.Demonstrate proficiency in the use of databases including Excel, CAQH, NPPES, Licensing Boards, and submit provider enrollment applications using payer portals as required.Maintain confidentiality with providers’ personal information and uphold respect for privacy and regulatory requirementsProvide regular reports and updates regarding enrollment statuses and escalate to the Vice President of Credentialing, Training and Development any issues that require resolution beyond the Provider Enrollment and Education [Coordinator or Administrator’s] scope of responsibility or pose a risk to meeting deadlines, standards or goals.Conduct audits of provider files.Maintain accurate records of live and online training activities, including participant information, attendance and completion status as well as supervisory requirements for professional certification programs and/or national accrediting agencies.Provide administrative support for live and online training and educational partnerships between HSMC’s client companies and higher education institutions.