Job Details

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Overview

Responsible for coordinating the timely and accurate credentialing and re-credentialing of providers with contracted commercial carriers, and their appropriate carve-out vendors, and assisting with the CT Medicaid & Medicare enrollment and re-enrollment processes of provider. Researches claim reimbursement issues due to provider enrollment and help to facilitate resolution.

Required Skills and Abilities

1. Comprehensive knowledge of medical credentialing for managed care companies, provider enrollment processes requirements and terminology for commercial insurance companies and government sponsored plans e.g. Medicare and Medicaid, as well as relevant terminology.

2. Strong grasp of regulatory, health plan and physician organization accrediting standards. Working knowledge of Medicaid and Medicare payer systems.

3. Excellent oral and written communication skills; ability to compose written/electronic communication independently. Ability to respond to inquiries from internal and external clients promptly and accurately.

4. Ability to prioritize multiple work assignments in varying stages of completion with a high degree of accuracy and attention to detail to meet complex goals and deadlines, as well as ability to exercise independent judgment and work well under pressure.

5.Strong computer skills (Word, Access, Excel). Strong organizational and customer service skills. Ability to maintain a high level of confidentiality.

Preferred Skills and Abilities

1. Advanced Access database skills including ability to create reports and queries.

2. Three years of recent medical credentialing experience.

Principal Responsibilities

1. Coordinates the review of credentialing applications for participation with managed care organizations, their vendors, and delegated entities. Reviews and monitors applications to assure data is correct and consistent, and alerts departments to research and respond with accurate or missing information in order to timely process credentialing files. 2. Reviews and categorizes files for appropriate level of peer review and the rendering of a credentialing decision in order to provide prompt notification to contracted entities. 3. Assists with the CT Medicaid & Medicare enrollment processes and researches denials, re-enrolling deactivated providers as appropriate. Maintains documentation of provider enrollment and re-enrollment with federal, state and private payers. 4. Establishes and maintains an effective means of communication internally with clinical practice managers and coordinators, insurance carriers, and other sources in order to obtain required information for YMA credentialing application processing as necessary. Serve as primary contact with clinical departments for problem solving, education, and enhancements. 5. Coordinates enrollment and participation of ancillary services and departments with contracted carriers and their carve-out vendors. Monitors privileging requirement and manage process to ensure ongoing compliance. 6. Develops and maintains effective workflow and methods of resolutions with contracted carriers to ensure consistent and accurate provider enrollment. Conducts research of claim reimbursement issues due to provider enrollment and helps to facilitate resolution. 7. Monitors and performs input of required data to the credentialing Physician Database obtaining data from managed care organizations, their vendors, delegated entities, government programs, and clinical departments as appropriate. 8. Assists in the development, preparation and implementation of training for clinical departments, managed care coordinators and reimbursement staff on the managed care, CT Medicare, and Medicaid enrollment process. 9. Collaborates with other credentialing, reimbursement and administrative staff on development of improvements to the credentialing process to increase efficiency and decrease the timeline surrounding provider enrollment with contracted carriers. 10. May perform other duties as assigned.

Required Education and Experience

Eight years of related work experience, six of them in the same job family at the next lower level and a high school level education; or six years of related work experience and an Associate's Degree; or two years of related work experience and a Bachelor's Degree; or an equivalent combination of education and related experience.

Required License(s) or Certification(s)

Required License(s) or Certification(s):

Physical Requirements

Physical Requirements:

Job Posting Date
04/14/2026

Job Category
Administrative Support

Bargaining Unit
L34

Compensation Grade
Labor Grade E

Compensation Grade Profile

Hourly Range
$35.64

Time Type
Full time

Duration Type
Staff

Work Model
Remote

Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Health Requirements

Certain positions have associated health requirements based on specific job responsibilities. These may include vaccinations, tests, or examinations, as required by law, regulation, or university policy.

Posting Disclaimer

The hiring rate of a role is determined in accordance with the provisions outlined in the respective collective bargaining agreement.

The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job-related duties through their hiring department.

The University is committed to basing judgments concerning the admission, education, and employment of individuals upon their qualifications and abilities and seeks to attract to its faculty, staff, and student body qualified persons from a broad range of backgrounds and perspectives. In accordance with this policy and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual's sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran.

Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).

Note

Yale University is a tobacco-free campus.