Credentialing Coordinator

Position Summary: Credentialing Coordinator

The Credentialing Coordinator plays a vital role in maintaining compliance and quality assurance within the healthcare organization. This essential, onsite position is responsible for verifying and processing credentials for medical professionals, ensuring all documentation meets regulatory, accreditation, and institutional standards.

Key Responsibilities:

• Credentialing Management: Manage and execute the initial credentialing and re-credentialing processes for physicians, nurses, and allied health professionals.
• Documentation Verification: Collect, verify, and maintain critical documentation such as licenses, certifications, insurance, records, and clinical documentation.
• Coordination: Coordinate effectively with internal departments (e.g., HR, Finance) and external agencies (e.g., State Boards, insurance payers) to ensure timely credentialing.
• Monitoring and Renewals: Monitor expiration dates meticulously and proactively initiate renewal and re-appointment processes to ensure continuous compliance and service delivery.
• Database Maintenance: Maintain accurate and up-to-date records in credentialing databases and systems.
• Compliance: Ensure compliance with federal, state, and relevant accreditation standards (e.g., NCQA, JCAHO/The Joint Commission).
• Inquiries & Support: Respond to inquiries from providers and staff regarding credentialing status, requirements, and policies.
• Reporting: Prepare accurate reports and documentation for internal reviews, audits (including HRSA/FQHC requirements), and internal quality committees.
  
  

Requirements:

Skills and Qualifications

• High school diploma or equivalent (Associate's or Bachelor's degree preferred).
• A minimum of two (2) years of experience in credentialing or healthcare administration is required.
• Strong attention to detail and exceptional organizational skills.
• Excellent communication skills, both written and verbal, for effective interaction with providers and external entities.
• Proficiency in credentialing software and Microsoft Office Suite (Word, Excel).
• Solid knowledge of healthcare regulations and credentialing standards.
  
  

Required Qualifications (Experience)

• Experience with common credentialing databases.
• Familiarity with insurance provider enrollment processes.
  
  

Benefits:

• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
  
  

Requirements

Key Responsibilities:

• Credentialing Management: Manage and execute the initial credentialing and re-credentialing processes for physicians, nurses, and allied health professionals.
• Documentation Verification: Collect, verify, and maintain critical documentation such as licenses, certifications, insurance, records, and clinical documentation.
• Coordination: Coordinate effectively with internal departments (e.g., HR, Finance) and external agencies (e.g., State Boards, insurance payers) to ensure timely credentialing.
• Monitoring and Renewals: Monitor expiration dates meticulously and proactively initiate renewal and re-appointment processes to ensure continuous compliance and service delivery.
• Database Maintenance: Maintain accurate and up-to-date records in credentialing databases and systems.
• Compliance: Ensure compliance with federal, state, and relevant accreditation standards (e.g., NCQA, JCAHO/The Joint Commission).
• Inquiries & Support: Respond to inquiries from providers and staff regarding credentialing status, requirements, and policies.
• Reporting: Prepare accurate reports and documentation for internal reviews, audits (including HRSA/FQHC requirements), and internal quality committees.
  
  

Requirements:

Skills and Qualifications

• High school diploma or equivalent (Associate's or Bachelor's degree preferred).
• A minimum of two (2) years of experience in credentialing or healthcare administration is required.
• Strong attention to detail and exceptional organizational skills.
• Excellent communication skills, both written and verbal, for effective interaction with providers and external entities.
• Proficiency in credentialing software and Microsoft Office Suite (Word, Excel).
• Solid knowledge of healthcare regulations and credentialing standards.
  
  

Required Qualifications (Experience)

• Experience with common credentialing databases.
• Familiarity with insurance provider enrollment processes.