Edtech.com's Summary

Columbia University is hiring a Senior Provider Enrollment Credentialing Coordinator. This role leads and manages enrollment functions for various payer types, ensuring provider records are accurate and compliant while coordinating complex enrollment scenarios and auditing payer rosters. The coordinator also supports credentialing activities to maintain workflow continuity and compliance.

Highlights

Manage full-cycle enrollment and credentialing for delegated, non-delegated, government, and third-party payers.
Perform quality assurance reviews and maintain accurate provider files and databases.
Utilize payer portals such as PECOS, Availity, and eMedNY for real-time profile updates and enrollment tracking.
Lead comprehensive roster audits to ensure data integrity at individual, group, and location levels.
Support process improvements, strategic projects, and communication with stakeholders.
Required proficiency in Microsoft Excel, including VLOOKUP and pivot tables.
Minimum of a bachelor's degree and 3 years related experience in provider enrollment, credentialing, or healthcare operations.
Strong analytical, problem-solving, communication, and time management skills.
Preferred experience with credentialing platforms (MD-Staff, IntelliCred, symplr, Cactus) and government enrollment systems.
Salary range between $64,800 and $80,000 annually, reflecting New York City Metropolitan market rates.

Senior Provider Enrollment Credentialing Coordinator Full Description

Job Type: Officer of Administration
Regular/Temporary: Regular
Hours Per Week: 35
Standard Work Schedule: 9AM-5PM, M-F
Building: 400 Kelby Street, Fort Lee NJ
Salary Range: $64,800.00 - $80,000.00

The compensation range listed in this job posting reflects the market rate for the New York City Metropolitan area. Actual compensation may vary depending on the geographic location of the candidate, in accordance with local labor market conditions.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. 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 leads enrollment functions for delegated, non-delegated, government, and third-party payers/vendors. This role supports enrollment, reenrollment, profile maintenance, updates, disenrollments, and resolution of payer-related issues. The coordinator ensures that provider records are accurate, compliant, and maintained in accordance with enrollment timelines, payer requirements, and internal standards. It also plays a key role in auditing payer rosters to ensure providers are enrolled correctly at the individual (NPI), group (TIN), and location level, as well as verifying credentials align with payer records. While the core focus is enrollment, the role may support credentialing activities as needed to maintain workflow continuity and compliance.

Responsibilities

Technical & Analytical

Manage full-cycle enrollment and credentialing tasks for delegated, non-delegated, government, and third-party payers/vendors.
Independently prepare, maintain, submit, and track individual and group provider enrollment submissions, including applications, delegated roster files, revalidations, group linkages, demographic changes, and terminations.
Manage and coordinate complex enrollment scenarios, including large group changes, off-cycle submissions, delegated roster processing, provider transitions across payer networks and product types (e.g., OPRA to FFS), and out-of-state enrollment. Oversee all aspects from requirement identification to recredentialing follow-up, and lead high-priority or retroactive submissions, ensuring timely escalation and resolution as needed.
Conduct thorough quality assurance (QA) reviews during application preparation to ensure file accuracy, completeness, and compliance with payer-specific requirements and documentation standards. Ensure documentation integrity and full adherence to established submission timelines and payer requirements.
Maintain accurate and organized provider files in accordance with internal record-keeping standards.
Oversee and update payer-specific forms, enrollment workflows, and documentation to ensure alignment with evolving payer requirements and internal SOPs.
Manage payer portals (e.g., PECOS, Availity, eMedNY) to ensure real-time profile updates and enrollment tracking; serve as Delegated Official or PECOS Surrogate for government payers; determine appropriate application types (e.g., full enrollment, group link, revalidation); and submit secondary applications to resolve or supplement existing records as needed.
Oversee the tracking and documentation of enrollment applications from initiation through confirmation. Conduct follow-up with payers via email, phone, and online systems to verify receipt, address issues, and confirm approvals. Ensure internal databases reflect accurate status and proactively identify and resolve delays. Provide leadership and stakeholders with regular updates on enrollment progress, outstanding items, and escalated concerns. Escalate incomplete submissions, delays, or errors according to escalation protocols.
Manage and oversee provider profile maintenance activities, ensuring timely and accurate updates to licenses, DEA registrations, specialties, TINs, service addresses, hospital affiliations, board certifications, and more to maintain compliance and integrity of payer enrollment records.
Follow up with departments to obtain missing documentation or signatures to support timely application submission.
Log, troubleshoot, and track complex enrollment-related issues such as denials/underpayments, authorization issues, or other participation errors. Collaborate with internal departments and payer contacts to complete a comprehensive root-cause analysis, following through to resolution to minimize adverse impact to revenue and patient/provider abrasion. Escalate issues appropriately for review and resolution.
Lead comprehensive roster audits across all major payers and product lines to ensure data integrity and compliance. (EX: PAR/NONPAR Status: Identify and coordinate resolution of participation discrepancies. Demographics: Verify NPI, TIN, and address accuracy across internal records and payer rosters. Credentialing: Reconcile licenses, board certifications, and specialties with payer records. Other: Conduct specialized audits related to fee schedules, Medicaid PAR status, ETIN connectivity, and upcoming recredentialing dates.)
Coordinate across cross-functional teams to ensure alignment of enrollment records with onboarding timelines and downstream billing processes.
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 the supervisor for improvements. Implements approved changes.
Lead or contribute to strategic projects, including annual open enrollment, payer platform migrations, system transitions, and high-volume bulk submissions.
Effectively communicate through informal and formal presentations for various audiences to ensure relevant communication is cascaded to the various interest and stakeholder groups as needed.
Develop and maintain workflow tools, trackers, and templates to improve efficiency and accuracy.
Partner with leadership to identify trends, gaps, or process improvement opportunities related to enrollment performance or payer feedback.
Prepares and distributes status updates to stakeholders for accurate and timely updating of internal and external platforms (including but not limited to databases, credentialing grids, dictionaries, portals, and websites).
Support credentialing activities as needed to maintain workflow continuity and compliance.

Compliance and Other

Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures.
Maintain subject matter expertise on payer requirements, state regulations, and industry best practices. Regularly update payer-specific workflows, documentation policies, and contact resources to ensure compliance with HIPAA, NCQA, payer requirements, and regulatory guidelines. Advise team on operational impacts of industry changes (e.g., CMS updates, Medicaid policy shifts).
Lead process improvement initiatives by identifying systemic workflow inefficiencies and recommending strategic enhancements to leadership.
Serves as the primary point of contact for providers, payers, and vendors. Lead regular meetings to discuss the status of open items and deliverables, preparing agendas in advance, and follow up with meeting minutes. Escalates to internal and external stakeholders as needed.
Participate and serve as a key contributor in internal meetings, cross-functional workgroups, audit preparation, and department initiatives as assigned. Document key discussion points and follow up on assigned action items.
Serve as the primary point of contact for internal inquiries, providing timely updates and guidance on enrollment status, payer requirements, and documentation needs.
Manage and prioritize complex work queues to ensure the timely resolution of enrollment submissions in alignment with departmental goals and payer expectations.
Establish and maintain positive relationships with payers, providers, practices, and administration, providing subject matter expertise and tailoring communications to adapt to each audience.
Mentor, train, complete quality assurance activities, and provide escalation support to team members.

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, are required.
Must demonstrate effective communication skills both verbally and in writing.
Must successfully complete systems training requirements.

Preferred Qualifications

Experience working in academic medical centers, health plans, or multi-specialty healthcare organizations
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

Other Requirements

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
Performance Management | Level 2 - Basic

Equal Opportunity Employer / Disability / Veteran

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

Original Job Description

Job Type: Officer of Administration
Regular/Temporary: Regular
Hours Per Week: 35
Standard Work Schedule: 9AM-5PM, M-F
Building: 400 Kelby Street, Fort Lee NJ
Salary Range: $64,800.00 - $80,000.00

Position Summary

Responsibilities

Technical & Analytical

Manage full-cycle enrollment and credentialing tasks for delegated, non-delegated, government, and third-party payers/vendors.
Independently prepare, maintain, submit, and track individual and group provider enrollment submissions, including applications, delegated roster files, revalidations, group linkages, demographic changes, and terminations.
Manage and coordinate complex enrollment scenarios, including large group changes, off-cycle submissions, delegated roster processing, provider transitions across payer networks and product types (e.g., OPRA to FFS), and out-of-state enrollment. Oversee all aspects from requirement identification to recredentialing follow-up, and lead high-priority or retroactive submissions, ensuring timely escalation and resolution as needed.
Conduct thorough quality assurance (QA) reviews during application preparation to ensure file accuracy, completeness, and compliance with payer-specific requirements and documentation standards. Ensure documentation integrity and full adherence to established submission timelines and payer requirements.
Maintain accurate and organized provider files in accordance with internal record-keeping standards.
Oversee and update payer-specific forms, enrollment workflows, and documentation to ensure alignment with evolving payer requirements and internal SOPs.
Manage payer portals (e.g., PECOS, Availity, eMedNY) to ensure real-time profile updates and enrollment tracking; serve as Delegated Official or PECOS Surrogate for government payers; determine appropriate application types (e.g., full enrollment, group link, revalidation); and submit secondary applications to resolve or supplement existing records as needed.
Oversee the tracking and documentation of enrollment applications from initiation through confirmation. Conduct follow-up with payers via email, phone, and online systems to verify receipt, address issues, and confirm approvals. Ensure internal databases reflect accurate status and proactively identify and resolve delays. Provide leadership and stakeholders with regular updates on enrollment progress, outstanding items, and escalated concerns. Escalate incomplete submissions, delays, or errors according to escalation protocols.
Manage and oversee provider profile maintenance activities, ensuring timely and accurate updates to licenses, DEA registrations, specialties, TINs, service addresses, hospital affiliations, board certifications, and more to maintain compliance and integrity of payer enrollment records.
Follow up with departments to obtain missing documentation or signatures to support timely application submission.
Log, troubleshoot, and track complex enrollment-related issues such as denials/underpayments, authorization issues, or other participation errors. Collaborate with internal departments and payer contacts to complete a comprehensive root-cause analysis, following through to resolution to minimize adverse impact to revenue and patient/provider abrasion. Escalate issues appropriately for review and resolution.
Lead comprehensive roster audits across all major payers and product lines to ensure data integrity and compliance. (EX: PAR/NONPAR Status: Identify and coordinate resolution of participation discrepancies. Demographics: Verify NPI, TIN, and address accuracy across internal records and payer rosters. Credentialing: Reconcile licenses, board certifications, and specialties with payer records. Other: Conduct specialized audits related to fee schedules, Medicaid PAR status, ETIN connectivity, and upcoming recredentialing dates.)
Coordinate across cross-functional teams to ensure alignment of enrollment records with onboarding timelines and downstream billing processes.
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 the supervisor for improvements. Implements approved changes.
Lead or contribute to strategic projects, including annual open enrollment, payer platform migrations, system transitions, and high-volume bulk submissions.
Effectively communicate through informal and formal presentations for various audiences to ensure relevant communication is cascaded to the various interest and stakeholder groups as needed.
Develop and maintain workflow tools, trackers, and templates to improve efficiency and accuracy.
Partner with leadership to identify trends, gaps, or process improvement opportunities related to enrollment performance or payer feedback.
Prepares and distributes status updates to stakeholders for accurate and timely updating of internal and external platforms (including but not limited to databases, credentialing grids, dictionaries, portals, and websites).
Support credentialing activities as needed to maintain workflow continuity and compliance.

Compliance and Other

Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures.
Maintain subject matter expertise on payer requirements, state regulations, and industry best practices. Regularly update payer-specific workflows, documentation policies, and contact resources to ensure compliance with HIPAA, NCQA, payer requirements, and regulatory guidelines. Advise team on operational impacts of industry changes (e.g., CMS updates, Medicaid policy shifts).
Lead process improvement initiatives by identifying systemic workflow inefficiencies and recommending strategic enhancements to leadership.
Serves as the primary point of contact for providers, payers, and vendors. Lead regular meetings to discuss the status of open items and deliverables, preparing agendas in advance, and follow up with meeting minutes. Escalates to internal and external stakeholders as needed.
Participate and serve as a key contributor in internal meetings, cross-functional workgroups, audit preparation, and department initiatives as assigned. Document key discussion points and follow up on assigned action items.
Serve as the primary point of contact for internal inquiries, providing timely updates and guidance on enrollment status, payer requirements, and documentation needs.
Manage and prioritize complex work queues to ensure the timely resolution of enrollment submissions in alignment with departmental goals and payer expectations.
Establish and maintain positive relationships with payers, providers, practices, and administration, providing subject matter expertise and tailoring communications to adapt to each audience.
Mentor, train, complete quality assurance activities, and provide escalation support to team members.

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, are required.
Must demonstrate effective communication skills both verbally and in writing.
Must successfully complete systems training requirements.

Preferred Qualifications

Experience working in academic medical centers, health plans, or multi-specialty healthcare organizations
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

Other Requirements

Equal Opportunity Employer / Disability / Veteran

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

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Senior Provider Enrollment Credentialing Coordinator

Edtech.com's Summary

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