Credentialing and Enrollment Account Rep

C&E Account Representative

1. Manage Assigned Client Accounts – Serve as the primary point of contact and coordinate credentialing and enrollment activities across each client’s assigned providers, locations, and payers.
2. Manage Commercial and Medicaid Enrollment – Complete enrollment, revalidation, demographic updates, location additions, terminations, and other maintenance activities for assigned commercial, managed care, and state Medicaid payers.
3. Maintain State Medicaid Portals When Assigned – Manage client and provider information within assigned state Medicaid portals, monitor revalidation and maintenance requirements, respond to requests for additional information, and protect portal access and sensitive data.
4. Coordinate Medicare Responsibilities – Collaborate with the Medicaid and Medicare Account Representative when Medicare enrollment is assigned to that role, maintaining clear ownership and sharing required provider and organizational information.
5. Monitor Applications and Follow-Up – Track submissions, payer communications, effective dates, outstanding documentation, and follow-up activity through completion, escalating barriers that could affect participation or reimbursement.
6. Maintain Accurate Records and Reporting – Keep MDStaff, reference spreadsheets, client reports, payer portals, and supporting documentation complete, current, and consistent.
7. Communicate With Clients and Internal Teams – Provide timely status updates, clearly identify outstanding needs, and coordinate next steps with clients, account leads, and specialized enrollment staff.