Credentialing Coordinator

Position Summary

The Credentialing Coordinator is responsible for verifying maintaining and monitoring the credentials of all clinical staff to ensure compliance with state federal and organizational requirements. This role plays a critical part in protecting patient safety maintaining regulatory compliance and supporting operational excellence by ensuring all credentialing files are accurate complete current and confidential.

Key Responsibilities

Credentialing & Verification

• Confirm that all required licenses certifications and credentials for staff members are current and valid
• Gather review and verify provider credentials including licenses certifications education training and work history
• Identify discrepancies or gaps in credentialing information and follow up to investigate and resolve issues
• Implement and manage the credential renewal process to ensure timely updates and prevent lapses

File & Data Management

• Maintain complete accurate and up-to-date credentialing files for all credentialed providers.
• Ensure credentialing documentation is properly stored and data is backed up according to organizational standards
• Preserve strict confidentiality of all employee and provider information

Compliance & Reporting

• Ensure credentialing activities comply with applicable state federal payer and organizational requirements
• Prepare credentialing reports for management committees and audits as needed
• Respond to external credentialing inquiries from payers regulatory agencies and other organizations

Communication & Coordination

• Serve as a point of contact for internal staff providers licensing boards and insurance networks regarding credentialing matters
• Screen credentialing applications and prepare materials for review by credentialing committees

Essential Skills & Qualifications

Skills

• Exceptional attention to detail and organizational skills
• Strong written and verbal communication abilities
• Effective problem-solving and follow-up skills
• Ability to manage multiple deadlines and priorities

Knowledge & Experience

• Working knowledge of healthcare credentialing regulatory compliance and verification processes
• Experience with credentialing databases or credentialing software preferred

Qualifications

Required

• High school diploma or equivalent.
• 23 years of experience in provider credentialing provider enrollment or healthcare administration.
• Strong knowledge of credentialing processes and primary source verification.
• Experience working with health plans hospitals and provider networks.
• Proficiency with credentialing software databases and online verification systems.
• Excellent attention to detail organization and time management skills.
• Strong written and verbal communication skills.

Preferred

• Associates or Bachelors degree in healthcare administration business or a related field.
• Experience with delegated credentialing programs.
• Familiarity with NCQA standards and CMS requirements.
• Credentialing certification (CPCS CPMSM or equivalent).

What We Offer

• • Competitive compensation
  • Comprehensive benefits package
  • Supportive collaborative team environment
  • Opportunity to work in a mission-driven healthcare organization
  • Professional growth and development opportunities

Required Experience:

IC