CLIENT RELATIONS COORDINATOR
As a member of the Health Care Service team, this role is accountable for end-to-end management and completion of hospital credentialing/ recredentialing applications, provider enrollment applications and issue resolution to ensure all providers and locations of assigned clients get enrolled in the appropriate commercial, state, and federal health plans.
A significant scope of this role is responsible to foster positive relationships with clients and oversee the day-to-day relations with clients, their personnel and providers. This individual’s daily functions include working independently with clients, their personnel, providers, health plans, and hospital leaders effectively to accomplish the various elements to ensure timely and accurate completion of their assigned tasks. The CRC must deliver exceptional client service, which is an expectation representing Anders vision, mission and core values.
- Ensures enrollment packets are appropriately signed, complete and accurate, and contain the necessary attachments
- Set-up and manage providers in the enrollment software
- Data entry of practitioner information into enrollment databases such as PECOS and/or various enrollment portals and ensures that the information in the databases is current and accurate.
- Verify NPIs and other customer enrollment information
- Review provider CAQH profiles and verifies that all pertinent elements are captured in the pertinent enrollment databases
- Follow up on credentialing requests and applications on a regular schedule that will result in faster turnaround times as requested by Team Leads
- Communicate payor enrollment and credentialing statuses as needed with Team Leads
- Escalate and communicate any at-risk client concerns/issues to Team Lead
- Keep customers informed and up to date regarding provider renewals, expirations, and application processes
- Monitor provider credentials and licenses to ensure timely renewals
- Tracks essential steps taken in the enrollment process and logs the actions in the enrollment database
- Enters payer Provider Identification Numbers (PINs) and the effective date into the credentialing system once they are received
- Will communicate with Managed Care on an ongoing basis as to status of payer contracts and other various enrollment issues
- Maintenance of physician enrollment and CAQH profiles as requested by Team Leads
- Maintain and keep up to date on all payor enrollment requirements
- Attend client meetings as needed and/or required
- Document and communicate updated payor credentialing requirements externally and internally
- Serve as enrollment and credentialing subject matter resource internally and externally