Credentialing Associate

Job Title: Credentialing Associate
Location: Corporate Office (On-Site) – Coastal Health

Position Overview:
The Credentialing Associate is responsible for managing all aspects of the credentialing and privileging process for medical providers delivering patient care for Coastal Health. This role ensures providers are properly credentialed, appointed, and privileged with health plans, hospitals, and other care facilities, while maintaining accurate and up-to-date provider records.

Key Responsibilities:

• Compile and maintain accurate, current credentialing data for all providers.
• Complete and submit provider credentialing and re-credentialing applications; track progress and follow up as needed.
• Maintain updated records of state licenses, DEA certificates, malpractice insurance, and other required documentation.
• Track and ensure timely renewal of licenses, certifications, DEA registrations, and liability coverage.
• Maintain corporate provider contract files and credentialing documentation.
• Ensure provider information is accurate and up to date across credentialing databases and online systems.
• Monitor and maintain compliance with current health plan, hospital, and regulatory credentialing requirements.
• Coordinate initial appointments and reappointments for provider privileges within PGS.
• Maintain organized credentialing and privileging files for all appointed providers.
• Ensure provider demographic and practice location information is current with health plans and relevant agencies.
• Conduct regular audits of health plan directories to ensure accuracy of provider listings.

Qualifications:

• High school diploma or equivalent required; associate’s or bachelor’s degree preferred.
• Prior experience in medical credentialing, healthcare administration, or a related field preferred.
• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines.
• Knowledge of credentialing standards (e.g., NCQA, Joint Commission) is a plus.
• Proficiency in Microsoft Office and credentialing software/databases.

Work Environment:
This position is based at our corporate office and requires on-site attendance. It is not a remote role.

Requirements

• Proficiency in Microsoft Office software (Word, Excel, and Outlook)
• Excellent verbal communication skills, and the ability to communicate effectively with physicians
• Maintain high levels of organization while being detail oriented
• Capable of meeting time-sensitive deadlines
• Ability to prioritize tasks efficiently and effectively
• Capable of working independently

Experience:

• Medical Credentialing: 2 years (Preferred)
• Provider Enrollment: 2 years (Preferred)
• Payer experience (Required)
• Experience in a multi-specialty setting (Preferred)

Education:

• High school Diploma or equivalent (Required)