Credentialing and Enrollment Coordinator at Combine… · MX

Main responsibilities

• Own the end-to-end credentialing, re-credentialing and payer enrollment cycle for all licensed providers of care (LCSW, LMHC, MD, PA, NPP and other behavioural health and medical staff).

• Clear the current backlog as the first priority: there are providers still with the agency whose applications have lapsed since July, which puts billing at risk today.

• Run enrollment, revalidation and maintenance in PECOS (Medicare/CMS), NPPES and CAQH ProView, and in the New York State environment — OPRA / eMedNY (NYS Medicaid), OMH and OASAS registries.

• Maintain provider files and licensure records so the agency can evidence, at any moment, that each rendering provider was valid at the time of service.

• Execute primary source verification of state licenses, DEA certificates, malpractice coverage and education history, in line with NCQA, NYS DOH and NYSED parameters.

• Chase and support employees directly: roughly half of the current owner's day is spent working with clinicians so they submit paperwork and keep their own licences alive.

• Partner with HR, Talent Acquisition and Program Directors to credential new hires at onboarding and shorten time-to-productivity.

• Investigate and audit enrollment-related claim rejections with the billing team; correct data in clearinghouses and state payer registries.

• Maintain the credentialing databases and build/present dashboards (Tableau) on pipeline, expiration timelines and application aging.

• Use generative AI tools (Claude, Microsoft Copilot) to summarise changing regulations, draft compliance correspondence and automate administrative work.

• Take on other projects assigned by the Senior Director — the agency expects flexibility across projects.

Skills

Must have:

• Credentialing and enrollment in US healthcare — advanced, 3–5 years, end to end
• English, written and spoken — C1/C2 (B2 accepted for an otherwise exceptional candidate)
• Systems and payers: PECOS, NPPES, CAQH ProView, Medicare and Medicaid enrollment — hands-on user

Nice to have:

• New York State environment: OPRA/eMedNY, OMH, OASAS, NYSED — strong differentiator
• Reporting and AI tooling: Tableau dashboards plus generative AI (Claude, Microsoft Copilot) — openness is mandatory
• CPCS or CPMSM certification

Traits

Must have:

• Runs the desk alone and raises questions early instead of guessing
• Chases clinicians until the paperwork arrives
• Learns an unfamiliar regulatory environment fast and takes on work beyond the job description