Edtech.com's Summary

Columbia University is hiring a Senior Enrollment Coordinator for CAP IPA. The role requires managing provider enrollment processes with Managed Care Payers, including direct provider engagement, credentialing and contracting guidance, enrollment verification, issue resolution, and roster management to ensure accurate and timely communication between providers and health plans.

Highlights

Primary representative for provider enrollment with Managed Care Payers.
Manage enrollment applications, contract submissions, and provider status updates.
Resolve enrollment, authorization, and claim-related issues through payer engagement.
Conduct regular roster audits and reconcile enrollment data with Medicare/Medicaid databases.
Lead payer meetings and maintain strong communication channels.
Proficiency in Microsoft Excel (VLOOKUP, pivot tables) required.
Bachelor's degree or equivalent with minimum 3 years healthcare enrollment or operations experience.
Preferred experience with credentialing platforms (MD-Staff, symplr, etc.) and government enrollment systems (PECOS, eMedNY).
Salary range: $75,000 - $80,000 annually.
Must maintain compliance with NCQA, HIPAA, and managed care payer regulations.

Senior Enrollment Coordinator Full Description

Job Type: Officer of Administration
Hours Per Week: 40
Standard Work Schedule: 8AM-5PM, M-F
Building: Fort Lee, NJ
Salary Range: $75,000 - $80,000

The compensation range in this job posting is based on market data for comparable roles within the New York City Metropolitan area. Actual compensation will be determined based on a variety of factors, including but not limited to the candidate’s geographic location, experience, qualifications, and applicable labor market conditions. All compensation decisions will be made in compliance with relevant laws and regulations. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting.

Position Summary

The Senior Enrollment Coordinator for CAP IPA serves as the primary account representative for provider enrollment matters related to Managed Care Payers. The role involves direct provider engagement, guiding providers through credentialing and contracting, confirming plan enrollments, managing updates, and resolving enrollment, authorization, and claim-related issues. The coordinator acts as a key liaison between providers and health plans, ensuring clear communication, accurate enrollment, timely issue resolution, and detailed roster management.

Responsibilities

Technical

Enrollment Management:
- Serve as the primary point of contact for providers joining CAP IPA, assisting them in determining managed care plan participation options.
- Prepare, submit, and monitor enrollment applications and contracts, aligning submissions with provider choices and eligibility requirements.
- Confirm and communicate provider participation status upon payer approval, updating internal records accordingly.
- Submit necessary updates, including demographic changes, location adjustments, and provider termination requests promptly and accurately.
- Conduct systematic roster audits and reconciliation against Medicare/Medicaid databases, proactively identifying enrollment status discrepancies and communicating upcoming revalidation deadlines.
Provider Account Management & Issue Resolution:
- Act as the primary representative and direct contact for CAP IPA providers on enrollment-related matters.
- Address and resolve provider enrollment issues, claims denials, participation discrepancies, and authorization concerns by actively engaging with plans.
- Provide timely resolution updates and detailed issue tracking to both providers and internal stakeholders, escalating unresolved or critical issues as necessary.
- Maintain detailed records of recurring provider and payer issues, identifying trends and opportunities for process improvements and efficiency.
Roster Reconciliation & Data Accuracy:
- Conduct comprehensive roster audits regularly, validating provider participation status across managed care plans and escalating complex discrepancies to leadership.
- Identify and resolve enrollment discrepancies at the NPI, TIN, and practice location levels, working closely with payers to ensure accurate participation data.
- Audit credentialing and demographic data such as licenses, DEA certificates, board certifications, specialties, addresses, and group affiliations, ensuring alignment with payer records.
Payer Engagement & Meeting Leadership:
- Lead regular payer meetings, preparing structured agendas, facilitating focused discussions, driving outcomes, and assigning clear action items.
- Document meeting outcomes and distribute detailed recaps to internal teams and payers promptly after meetings, ensuring accountability and timely follow-up on outstanding issues.
- Maintain strong relationships with payer representatives, ensuring clear communication pathways for resolving enrollment, authorization, and claims-related issues.

Strategic

Works collaboratively with fellow team members to regularly evaluate the effectiveness of department Standard Operating Procedures and workflows and identify gaps. Provides feedback and recommendations to management for improvements. Implements approved changes.

People

Mentors others in individual and team accountability, modeling behavior, and demonstrating best practices/techniques.

Compliance

Performs other related duties as assigned within the scope of practice.
Maintain familiarity and stay current with NCQA requirements and health insurance plan procedures.
Maintain deep subject-matter expertise on payer enrollment requirements, managed care standards, and associated state regulations.
Monitor industry trends and regulatory updates, proactively advising internal teams and providers of operational impacts.
Collaborate closely with internal credentialing, billing, and revenue cycle teams to ensure data alignment, resolve discrepancies, and maintain regulatory compliance.
Represents PEG on committees, task forces, and work groups as assigned.
Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.

Please note: While this position is primarily remote, candidates must be in a Columbia University-approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the responsibility of the employee and will not be reimbursed by the company.

Minimum Qualifications

Bachelor’s degree or equivalent in education and experience.
Minimum of 3 years of related experience in provider enrollment, credentialing, or healthcare operations.
An equivalent combination of education and experience may be considered.
Must demonstrate strong analytical and problem-solving skills with attention to detail and accuracy.
Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
Demonstrate proficiency in Microsoft Excel functions, including VLOOKUP and pivot tables.
Advanced time management skills, including planning, organization, multi-tasking, and the ability to prioritize required.
Must demonstrate effective communication skills both verbally and in writing.
Must successfully complete systems training requirements.

Preferred Qualifications

Prior experience working at an academic medical center, health plans, or multi-specialty healthcare organization preferred.
Proficiency using credentialing platforms such as MD-Staff, IntelliCred, symplr, or Cactus.
Experience using government enrollment platforms such as PECOS, eMedNY, or Availity.
Experience managing group-level credentialing and enrollment for all payer types, including Out-of-State Medicaid.
Familiarity with payer-specific credentialing and enrollment requirements and workflows for government, delegated, and non-delegated plans.
Experience supporting NCQA-compliant delegated credentialing/enrollment programs or audits.
Experience performing complex enrollment activities, such as roster audits, directory maintenance, product line transitions, and issue resolution.
Strong understanding of NPI/TIN/location structures and their implications for payer enrollment.
Experience leading or coordinating provider enrollment activities during onboarding, offboarding, or large-scale practice transitions.
Prior involvement in vendor or payer relationship management (e.g., acting as primary liaison for delegated enrollment or credentialing partners).
Experience auditing or reviewing delegated rosters or enrollment files for accuracy and compliance.
Demonstrated ability to provide mentorship or training to junior staff or cross-functional colleagues.
Familiarity with payer portals and internal processes used to verify participation and resolve escalations.
Understanding of the connection between enrollment delays and claims, authorizations, or billing issues.
Experience with enrollment performance tracking or metrics reporting for leadership review.

Competencies

Patient Facing Competencies | Minimum Proficiency Level
Accountability & Self-Management | Level 3 - Intermediate
Adaptability to Change & Learning Agility | Level 2 - Basic
Communication | Level 2 - Basic
Customer Service & Patient-Centered | Level 3 - Intermediate
Emotional Intelligence | Level 2 - Basic
Problem Solving & Decision Making | Level 3 - Intermediate
Productivity & Time Management | Level 3 - Intermediate
Teamwork & Collaboration | Level 2 - Basic
Quality, Patient & Workplace Safety | Level 3 - Intermediate
Leadership Competencies | Minimum Proficiency Level
Business Acumen & Vision Driver | Level 1 - Introductory
Performance Management | n/a
Innovation & Organizational Development | Level 1 - Introductory

Equal Opportunity Employer / Disability / Veteran

Columbia University is committed to the hiring of qualified local residents.

Original Job Description

Job Type: Officer of Administration
Hours Per Week: 40
Standard Work Schedule: 8AM-5PM, M-F
Building: Fort Lee, NJ
Salary Range: $75,000 - $80,000

Position Summary

Responsibilities

Technical

Enrollment Management:
- Serve as the primary point of contact for providers joining CAP IPA, assisting them in determining managed care plan participation options.
- Prepare, submit, and monitor enrollment applications and contracts, aligning submissions with provider choices and eligibility requirements.
- Confirm and communicate provider participation status upon payer approval, updating internal records accordingly.
- Submit necessary updates, including demographic changes, location adjustments, and provider termination requests promptly and accurately.
- Conduct systematic roster audits and reconciliation against Medicare/Medicaid databases, proactively identifying enrollment status discrepancies and communicating upcoming revalidation deadlines.
Provider Account Management & Issue Resolution:
- Act as the primary representative and direct contact for CAP IPA providers on enrollment-related matters.
- Address and resolve provider enrollment issues, claims denials, participation discrepancies, and authorization concerns by actively engaging with plans.
- Provide timely resolution updates and detailed issue tracking to both providers and internal stakeholders, escalating unresolved or critical issues as necessary.
- Maintain detailed records of recurring provider and payer issues, identifying trends and opportunities for process improvements and efficiency.
Roster Reconciliation & Data Accuracy:
- Conduct comprehensive roster audits regularly, validating provider participation status across managed care plans and escalating complex discrepancies to leadership.
- Identify and resolve enrollment discrepancies at the NPI, TIN, and practice location levels, working closely with payers to ensure accurate participation data.
- Audit credentialing and demographic data such as licenses, DEA certificates, board certifications, specialties, addresses, and group affiliations, ensuring alignment with payer records.
Payer Engagement & Meeting Leadership:
- Lead regular payer meetings, preparing structured agendas, facilitating focused discussions, driving outcomes, and assigning clear action items.
- Document meeting outcomes and distribute detailed recaps to internal teams and payers promptly after meetings, ensuring accountability and timely follow-up on outstanding issues.
- Maintain strong relationships with payer representatives, ensuring clear communication pathways for resolving enrollment, authorization, and claims-related issues.

Strategic

Works collaboratively with fellow team members to regularly evaluate the effectiveness of department Standard Operating Procedures and workflows and identify gaps. Provides feedback and recommendations to management for improvements. Implements approved changes.

People

Mentors others in individual and team accountability, modeling behavior, and demonstrating best practices/techniques.

Compliance

Performs other related duties as assigned within the scope of practice.
Maintain familiarity and stay current with NCQA requirements and health insurance plan procedures.
Maintain deep subject-matter expertise on payer enrollment requirements, managed care standards, and associated state regulations.
Monitor industry trends and regulatory updates, proactively advising internal teams and providers of operational impacts.
Collaborate closely with internal credentialing, billing, and revenue cycle teams to ensure data alignment, resolve discrepancies, and maintain regulatory compliance.
Represents PEG on committees, task forces, and work groups as assigned.
Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.

Minimum Qualifications

Bachelor’s degree or equivalent in education and experience.
Minimum of 3 years of related experience in provider enrollment, credentialing, or healthcare operations.
An equivalent combination of education and experience may be considered.
Must demonstrate strong analytical and problem-solving skills with attention to detail and accuracy.
Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
Demonstrate proficiency in Microsoft Excel functions, including VLOOKUP and pivot tables.
Advanced time management skills, including planning, organization, multi-tasking, and the ability to prioritize required.
Must demonstrate effective communication skills both verbally and in writing.
Must successfully complete systems training requirements.

Preferred Qualifications

Prior experience working at an academic medical center, health plans, or multi-specialty healthcare organization preferred.
Proficiency using credentialing platforms such as MD-Staff, IntelliCred, symplr, or Cactus.
Experience using government enrollment platforms such as PECOS, eMedNY, or Availity.
Experience managing group-level credentialing and enrollment for all payer types, including Out-of-State Medicaid.
Familiarity with payer-specific credentialing and enrollment requirements and workflows for government, delegated, and non-delegated plans.
Experience supporting NCQA-compliant delegated credentialing/enrollment programs or audits.
Experience performing complex enrollment activities, such as roster audits, directory maintenance, product line transitions, and issue resolution.
Strong understanding of NPI/TIN/location structures and their implications for payer enrollment.
Experience leading or coordinating provider enrollment activities during onboarding, offboarding, or large-scale practice transitions.
Prior involvement in vendor or payer relationship management (e.g., acting as primary liaison for delegated enrollment or credentialing partners).
Experience auditing or reviewing delegated rosters or enrollment files for accuracy and compliance.
Demonstrated ability to provide mentorship or training to junior staff or cross-functional colleagues.
Familiarity with payer portals and internal processes used to verify participation and resolve escalations.
Understanding of the connection between enrollment delays and claims, authorizations, or billing issues.
Experience with enrollment performance tracking or metrics reporting for leadership review.

Competencies

Equal Opportunity Employer / Disability / Veteran

Columbia University is committed to the hiring of qualified local residents.

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Senior Enrollment Coordinator

Edtech.com's Summary

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