Credentialing Coordinator

Job Summary

Responsible for coordinating and managing the credentialing and recredentialing processes for physicians and advanced practice providers. This position ensures the timely and accurate collection, verification, and maintenance of credentialing documentation while supporting compliance with regulatory, accreditation, payer, and organizational requirements. The Credentialing Coordinator collaborates with providers, leadership, medical staff, and external agencies to facilitate credentialing activities, maintain provider records, and support physician onboarding and practice operations.

Essential Functions

• Coordinates and manages the credentialing process for new physicians and providers, including initial credentialing, recredentialing, and enrollment activities.

• Collects, reviews, verifies, and maintains credentialing documentation to ensure completeness, accuracy, and compliance with applicable requirements.

• Monitors provider licensure, malpractice insurance coverage, continuing medical education (CME), certifications, and other credentialing requirements.

• Assists providers in completing credentialing applications and required forms.

• Communicates and coordinates with state, federal, private, managed care, Medicare, Medicaid, and regulatory agencies regarding credentialing and enrollment matters.

• Maintains credentialing databases, files, and records in accordance with organizational policies and regulatory standards.

• Coordinates physician office startup and relocation activities related to credentialing, provider enrollment, and vendor relations.

• Tracks credentialing progress and communicates status updates to providers, leadership, and key stakeholders.

• Communicates changes in credentialing, enrollment, payer, and regulatory requirements to appropriate individuals and departments.

• Prepares correspondence, reports, credentialing packets, presentations, and related documentation.

• Attends meetings, conferences, and committee meetings as assigned and communicates relevant updates and action items.

• Serves as a resource to providers and staff regarding credentialing policies, procedures, and requirements.

• Maintains confidentiality of provider, patient, and organizational information in accordance with applicable policies and regulations.

• Supports departmental projects, operational initiatives, and process improvement activities.

• Performs other duties as assigned.

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills with the ability to communicate effectively with physicians, advanced practice providers, medical staff, leadership, hospital personnel, and external agencies.

• Knowledge of physician and provider credentialing requirements, processes, and regulatory standards.

• Ability to maintain confidentiality and handle sensitive information with professionalism and discretion.

• Strong computer skills, including proficiency in Microsoft Word, Excel, Outlook, and database applications.

• Strong data entry and documentation management skills.

• Ability to manage multiple projects, priorities, deadlines, and interruptions in a fast-paced environment.

• Strong organizational, time management, and problem-solving skills.

• Ability to review, analyze, and verify detailed information accurately.

• Ability to work independently and collaboratively across departments and organizational levels.

• Ability to prepare professional correspondence, reports, and presentations.

• Knowledge of healthcare operations, provider enrollment, licensing, accreditation, and payer requirements preferred.

• Strong customer service and relationship-building skills.

Education

• Associate Degree preferred.

• Field of Study

• Healthcare Administration, Business Administration, Health Information Management, or a related field preferred.

Work Experience

• Five years of administrative experience in a role requiring strong organizational, communication, and documentation skills, including at least three years within a healthcare organization required.

• Previous physician credentialing experience required.

Licenses and Certifications

• Certified Provider Credentialing Specialist (CPCS) preferred.

• Certified Professional Medical Staff Management (CPMSM) preferred.

Additional Information

• N/A.