Beacon Health System
Reports to the
Supervisor, Provider Enrollment & Credentialing . Responsible for the timely completion of all initial and re-credentialing processes, as well as payer enrollments, for
Beacon Health System . Coordinates with physicians, providers, credentialing agencies, regulatory bodies, payors, office managers, and contracted providers to ensure credentialing and enrollment activities comply with
National Committee on Quality Assurance (NCQA)
standards and departmental policies and procedures.
MISSION, VALUES, AND SERVICE GOALS MISSION:
We deliver outstanding care, inspire health, and connect with heart. VALUES:
Trust. Respect. Integrity. Compassion. SERVICE GOALS:
Personally connect. Keep everyone informed. Be on their team.
Primary Responsibilities Credentialing Ensures timely completion of credentialing activities in compliance with NCQA and departmental standards. Coordinates with external agencies, payors, office managers, and contracted providers to complete credentialing requirements. Acts as a liaison with Medical Directors, Hospital Medical Staff, and internal/external stakeholders regarding credentialing status. Performs
Primary Source Verifications
per applicable accreditation standards (JCAHO, AAAHC, URAC, etc.). Conducts online verifications and reviews relevant credentialing resources. Notifies appropriate entities of provider effective and termination dates. Communicates with the
Physician Recruitment
team regarding provider onboarding and credentialing status. Maintains regular follow-up with providers and communicates status updates to ensure credentialing completion prior to start dates.
Enrollment Ensures timely completion of all payer enrollment activities per payer requirements and departmental procedures. Completes insurance and government applications on behalf of Beacon Health System providers. Alerts management of any delays or non-compliance issues. Maintains accurate and up-to-date data in credentialing software systems. Provides timely reports as needed. Manages and updates each providers
CAQH online profile . Applies for and maintains Beacon Health System provider
NPPES (National Plan & Provider Enumeration System)
identifiers. Assists Beacon Medical Group and hospital Patient Accounts departments with network and claims issues related to credentialing. Adheres to strict follow-up schedules, ensuring all credentialing and enrollment steps are completed before provider start dates.
Organizational Responsibilities Attends and participates in department meetings; accountable for all information shared. Completes mandatory education, annual competencies, and department-specific training within required timeframes. Complies with annual employee health requirements and organizational/departmental policies.
Education and Experience High school diploma or equivalent required; Associates Degree in Business, Health Administration, or a related field preferred. Minimum of
three years of credentialing experience
or equivalent experience in healthcare or health insurance preferred.
Knowledge and Skills Working knowledge of
federal, state, and local laws
and
NCQA standards
applicable to credentialing and enrollment. Strong analytical, problem-solving, and organizational skills to enhance and streamline credentialing processes. Proficient in Microsoft Office Suite and standard office equipment. Excellent written and verbal communication skills. Strong interpersonal skills to build and maintain effective relationships with internal and external stakeholders.
Working Conditions Primarily office-based environment.
Physical Demands Requires physical ability and stamina to perform the essential functions of the position.
Supervisor, Provider Enrollment & Credentialing . Responsible for the timely completion of all initial and re-credentialing processes, as well as payer enrollments, for
Beacon Health System . Coordinates with physicians, providers, credentialing agencies, regulatory bodies, payors, office managers, and contracted providers to ensure credentialing and enrollment activities comply with
National Committee on Quality Assurance (NCQA)
standards and departmental policies and procedures.
MISSION, VALUES, AND SERVICE GOALS MISSION:
We deliver outstanding care, inspire health, and connect with heart. VALUES:
Trust. Respect. Integrity. Compassion. SERVICE GOALS:
Personally connect. Keep everyone informed. Be on their team.
Primary Responsibilities Credentialing Ensures timely completion of credentialing activities in compliance with NCQA and departmental standards. Coordinates with external agencies, payors, office managers, and contracted providers to complete credentialing requirements. Acts as a liaison with Medical Directors, Hospital Medical Staff, and internal/external stakeholders regarding credentialing status. Performs
Primary Source Verifications
per applicable accreditation standards (JCAHO, AAAHC, URAC, etc.). Conducts online verifications and reviews relevant credentialing resources. Notifies appropriate entities of provider effective and termination dates. Communicates with the
Physician Recruitment
team regarding provider onboarding and credentialing status. Maintains regular follow-up with providers and communicates status updates to ensure credentialing completion prior to start dates.
Enrollment Ensures timely completion of all payer enrollment activities per payer requirements and departmental procedures. Completes insurance and government applications on behalf of Beacon Health System providers. Alerts management of any delays or non-compliance issues. Maintains accurate and up-to-date data in credentialing software systems. Provides timely reports as needed. Manages and updates each providers
CAQH online profile . Applies for and maintains Beacon Health System provider
NPPES (National Plan & Provider Enumeration System)
identifiers. Assists Beacon Medical Group and hospital Patient Accounts departments with network and claims issues related to credentialing. Adheres to strict follow-up schedules, ensuring all credentialing and enrollment steps are completed before provider start dates.
Organizational Responsibilities Attends and participates in department meetings; accountable for all information shared. Completes mandatory education, annual competencies, and department-specific training within required timeframes. Complies with annual employee health requirements and organizational/departmental policies.
Education and Experience High school diploma or equivalent required; Associates Degree in Business, Health Administration, or a related field preferred. Minimum of
three years of credentialing experience
or equivalent experience in healthcare or health insurance preferred.
Knowledge and Skills Working knowledge of
federal, state, and local laws
and
NCQA standards
applicable to credentialing and enrollment. Strong analytical, problem-solving, and organizational skills to enhance and streamline credentialing processes. Proficient in Microsoft Office Suite and standard office equipment. Excellent written and verbal communication skills. Strong interpersonal skills to build and maintain effective relationships with internal and external stakeholders.
Working Conditions Primarily office-based environment.
Physical Demands Requires physical ability and stamina to perform the essential functions of the position.