Provider Enrollment Coordinator

Mary Washington Healthcare

About The Position

The Provider Enrollment Coordinator is responsible for completing and maintaining all aspects of provider enrollment with Medicare, Medicaid, commercial health plans, and delegated credentialing entities. This role ensures that providers are accurately credentialed and enrolled so they can bill for services without interruption. The coordinator supports new provider onboarding, maintains provider records, and collaborates with internal and external stakeholders to ensure compliance with payer and regulatory requirements.

Requirements

High school diploma required; Associate’s or Bachelor’s degree preferred.
A minimum of 1 year of experience required. Two or more years preferred.
Strong attention to detail and accuracy in data entry and documentation.
Excellent organizational skills with the ability to manage multiple tasks and deadlines.
Effective written and verbal communication skills.
Proficiency with Microsoft Office applications and credentialing databases.
Ability to work both independently and within a team environment.

Nice To Haves

Prior experience with Medicare/Medicaid processes and CAQH preferred.
Familiarity with credentialing software systems strongly preferred.

Responsibilities

Prepare, submit, and track provider enrollment applications to Medicare, Medicaid, and commercial payers.
Manage and maintain enrollments, including revalidations, recredentialing, terminations, and demographic updates.
Maintain and update CAQH profiles, ensuring timely attestation and documentation accuracy.
Collect, verify, and organize provider documents including licenses, board certifications, DEA, CDS, CVs, and malpractice insurance.
Process Medicare PECOS enrollments, reassignments and provider changes.
Ensure compliance with federal, state, and payer-specific enrollment and credentialing requirements.
Serve as a liaison between providers and payer representatives to streamline enrollment processes.
Coordinate with Recruiting, HR, Medical Support Services, and onboarding teams to ensure timely credentialing for new hires.
Coordinate with billing and reimbursement teams to resolve enrollment‑related claim edits, billing holds, and payment delays.
Research and resolve discrepancies while maintaining accurate documentation and records to support audits and compliance reviews.
Perform other duties as assigned.