Core Clinical Partners
Provider Enrollment Coordinator
Core Clinical Partners, Lafayette, Louisiana, United States, 70595
Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values - Genuine, Accountable, Dynamic, Respectful, and Fun - are the pillars that uphold our commitment to revolutionize healthcare delivery.
The Provider Enrollment Coordinator is responsible for the timely and accurate enrollment and re-enrollment of healthcare clinicians with government and commercial insurance payors. This role ensures that all required documentation is submitted to payors to establish and maintain participation status and billing privileges, thereby supporting timely reimbursement and compliance with regulatory and payor-specific requirements.
Essential Duties:
Prepare and submit provider enrollment and re-enrollment applications to Medicare, Medicaid, and commercial insurance payors -including Blue Cross Blue Shield and its regional subsidiaries. Maintain current knowledge of payor requirements, policies, and processes. Monitor application status and follow up with payors to ensure timely processing. Track and manage enrollment deadlines, effective dates, CAQH updates, and recredentialing requirements. Ensure accuracy and completeness of provider data in internal systems (e.g., NPI, licensure, DEA, malpractice, CV). Work closely with providers, HR, credentialing, and billing departments to gather necessary documentation. Communicate enrollment progress to internal stakeholders and escalate delays or issues as needed. Maintain and audit files to ensure documentation is up to date and compliant with regulatory standards. Assist with roster submissions, EFT forms, W-9s, and group affiliations as required. Aid in resolving enrollment issues that impact claims payment, including mismatch errors, taxonomy/NPI conflicts, and provider location linking. Support and guide fellow Provider Enrollment Specialists. Research new state and payor requirements for enrollment and re-enrollment to ensure compliance when entering new states. Perform other duties as assigned. Skills, Knowledge, Abilities:
Strong organizational skills with the ability to multi-task in a fast-paced environment. Ability to adapt, modify and prioritize while adhering to strict deadlines and a willingness to shift priorities to meet the needs of the organization. ability to interact with a variety of team members. Self-motivated with the ability to identify opportunities for improvement and demonstrate the initiative to resolve issues in support of improvement efforts. Proficient in Microsoft Office (Excel, Outlook, Word) and database systems. High attention to detail and accuracy. Collaborate with professionals internal and external to the company and across geographic locations. Exhibit growth mindset and team-orientated behaviors. Navigate competing priorities and effectively work in a fast-paced environment. Requirements
Education:
High school diploma or equivalent; Associate's or Bachelor's degree preferred. Experience:
Minimum 2 years of experience in healthcare provider enrollment, credentialing, or revenue cycle. Strong understanding of Medicare, Medicaid, and commercial payor enrollment processes. Familiarity with NPPES, PECOS, CAQH, Availity, and provider portals. Knowledge of state-specific Medicaid programs and enrollment nuances. Experience with medical billing or credentialing software.
The Provider Enrollment Coordinator is responsible for the timely and accurate enrollment and re-enrollment of healthcare clinicians with government and commercial insurance payors. This role ensures that all required documentation is submitted to payors to establish and maintain participation status and billing privileges, thereby supporting timely reimbursement and compliance with regulatory and payor-specific requirements.
Essential Duties:
Prepare and submit provider enrollment and re-enrollment applications to Medicare, Medicaid, and commercial insurance payors -including Blue Cross Blue Shield and its regional subsidiaries. Maintain current knowledge of payor requirements, policies, and processes. Monitor application status and follow up with payors to ensure timely processing. Track and manage enrollment deadlines, effective dates, CAQH updates, and recredentialing requirements. Ensure accuracy and completeness of provider data in internal systems (e.g., NPI, licensure, DEA, malpractice, CV). Work closely with providers, HR, credentialing, and billing departments to gather necessary documentation. Communicate enrollment progress to internal stakeholders and escalate delays or issues as needed. Maintain and audit files to ensure documentation is up to date and compliant with regulatory standards. Assist with roster submissions, EFT forms, W-9s, and group affiliations as required. Aid in resolving enrollment issues that impact claims payment, including mismatch errors, taxonomy/NPI conflicts, and provider location linking. Support and guide fellow Provider Enrollment Specialists. Research new state and payor requirements for enrollment and re-enrollment to ensure compliance when entering new states. Perform other duties as assigned. Skills, Knowledge, Abilities:
Strong organizational skills with the ability to multi-task in a fast-paced environment. Ability to adapt, modify and prioritize while adhering to strict deadlines and a willingness to shift priorities to meet the needs of the organization. ability to interact with a variety of team members. Self-motivated with the ability to identify opportunities for improvement and demonstrate the initiative to resolve issues in support of improvement efforts. Proficient in Microsoft Office (Excel, Outlook, Word) and database systems. High attention to detail and accuracy. Collaborate with professionals internal and external to the company and across geographic locations. Exhibit growth mindset and team-orientated behaviors. Navigate competing priorities and effectively work in a fast-paced environment. Requirements
Education:
High school diploma or equivalent; Associate's or Bachelor's degree preferred. Experience:
Minimum 2 years of experience in healthcare provider enrollment, credentialing, or revenue cycle. Strong understanding of Medicare, Medicaid, and commercial payor enrollment processes. Familiarity with NPPES, PECOS, CAQH, Availity, and provider portals. Knowledge of state-specific Medicaid programs and enrollment nuances. Experience with medical billing or credentialing software.