Credentialing Coordinator at HighFive Healthcare

Description

The Credentialing Coordinator plays a critical role in ensuring that all oral surgery and endodontic providers across HighFive Healthcare meet required credentialing standards with accuracy, timeliness, and confidentiality. This position is responsible for managing provider documentation, overseeing enrollment processes with payors, and maintaining detailed records to support operational, financial, and clinical teams. The ideal candidate is highly organized, detail-oriented, and comfortable working independently while delivering responsive support to internal stakeholders and third-party insurers.

Responsibilities

• Maintain a strict degree of confidentiality in all areas relating to oral surgery and endodontic provider credentials, status and provider’s personal information.
• Review all documentation with HighFive Healthcare’s Vice President of Payor Relations prior to submitting physician’s documents to the Credentialing Committee pertaining to any adverse information during the application process.
• Ensure all provider enrollment paperwork is complete and submitted to the appropriate parties in a timely manner and documented.
• Follow up with insurers until the process is complete.
• Document location ID numbers issued.
• Preserve a spreadsheet for all data pertaining to fee schedules at each HighFive Healthcare location.
• Maintain provider documentation and update as necessary.
• Provide support regarding physician enrollment to our operations department, finance team, and the clinical operations officer.
• Respond promptly to any and all provider or third-party insurance payer requests or questions.
• Maintain electronic records of provider’s credentials, CAQH and insurer logins.
• Process all requests to update provider demographic or practice information and forward to the appropriate third parties as necessary.
• Communicate with the Vice President of Payor Relations and Regional Directors regarding any or all credentialing delays or issues.
• Research state specific credentialing applications and import for mapping.
  
  

Requirements

• Bachelor’s degree from a four-year accredited university or college
• Have a minimum of 2 years credentialing experience
• Knowledge of Medicare and Medicaid is preferred
• CAQH experience is a BIG plus
• Knowledge of dental care and/or health care concepts and terminology preferred
• A high degree of organization, extreme attention to detail and follow through
• Above average interpersonal, verbal and written communication skills.
• Thorough knowledge of Microsoft Office applications, Adobe Acrobat DC and an overall degree of computer literacy
• Ability to work semi-autonomously and self-direct daily work
• A desire to explore and learn new things
  
  

Benefits

• Medical, Dental, and Vision Insurance
• Life Insurance
• Short- and Long-Term Disability Coverage
• Paid Time Off (PTO)
• 401(k) Retirement Plan with Company Match