Credentialing & Enrollment Coordinator

Position Overview:

The Credentialing & Enrollment Coordinator owns MyOme’s laboratory payer enrollment lifecycle, ensuring the lab is credentialed, enrolled, and set up to bill and get paid by every payer we work with. This role manages initial enrollments, revalidations, and maintenance across Medicare, Medicaid, and commercial payers, including the EDI claim and ERA/EFT enrollments that make electronic billing and payment possible. Working within our Revenue Cycle Management team, you will keep payer and provider data accurate in our billing system, so claims route correctly and remittances post cleanly. Your work directly protects cash flow and prevents denials as MyOme expands its payer network. The ideal candidate brings hands-on credentialing experience in a clinical laboratory or diagnostics setting, strong command of CMS-855B, PECOS, NPPES, and CAQH, and the organization to track dozens of applications and deadlines at once.

What You'll Do:

• Prepare, submit, and track laboratory enrollments and revalidations with Medicare (CMS-855B via PECOS), state Medicaid programs, Medicare Advantage, and commercial payers.
• Manage EDI claim enrollments (837) and ERA (835) and EFT enrollments with payers and clearinghouses, coordinating testing and go-live with the billing system vendor.
• Perform XiFin file maintenance, including payer, provider, NPI, and ordering-physician setup, so claims route and remittances post correctly.
• Maintain the lab’s credentialing data and documents, including NPPES, CAQH, CLIA and CAP certificates, state lab licenses, and W-9s, and track expiration and revalidation dates.
• Keep a credentialing and enrollment tracker current with application status, effective dates, payer IDs, and follow-up actions.
• Follow up with payers on pending applications and resolve enrollment-related denials, holds, and rejections with the billing team.
• Support network contracting by submitting post-contract enrollments and confirming loaded rates and effective dates.
• Report enrollment status, risks, and upcoming deadlines to RCM leadership, and flag anything that could delay billing.
• Document enrollment procedures and payer-specific requirements to build a repeatable process as the payer network grows.

What You'll Need:

• Associate’s degree required
• 3–5 years of credentialing and payer enrollment experience, including at least 2 years in a clinical laboratory, genetic testing, or diagnostics setting.
• Hands-on experience enrolling labs (facility/group enrollment, not only individual providers) with Medicare, Medicaid, and commercial payers.
• Working knowledge of CMS-855B, PECOS, NPPES, CAQH, and CLIA requirements, and how enrollment status affects claim adjudication.
• Demonstrated experience completing EDI (837) and ERA/EFT (835) enrollments with payers and clearinghouses.
• XiFin experience strongly preferred, including payer and provider file maintenance.
• Exceptional organization and attention to detail, with a track record of managing many concurrent applications and deadlines.
• Clear, persistent communicator who can work payer provider-relations teams to resolution.
• Proficiency in Excel or Google Sheets for tracking and reporting.

Location, Compensation, and Benefits:

• Location: Remote in the US
• Compensation: The hourly pay range for this role is $36.06–$40.86. Final pay will be determined based on factors such as skills, experience, and qualifications. This role is also eligible for equity.

San Francisco Bay Area pay range 36.06 - 40.86 USD