Credentialing Coordinator

The Credentialing Specialist is responsible for all aspects of the credentialing and payer enrollment process for all providers and facilities. They are responsible for ensuring providers and facilities are credentialed, and enrolled in accordance with established accreditation, regulatory and policy requirements. Maintain up-to-date data for each provider and facility in credentialing database and online systems.

Essential Duties and Responsibilities:

• Compiles and maintains current and accurate data for all providers using the credentialing software.
• Completes provider and facility payer enrollment applications; monitors applications to ensure timely start dates and no lapses in enrollment.
• Maintains copies and tracks current state licenses, DEA certificates, health history, malpractice coverage and any other required credentialing documents for all providers and facilities.
• Maintains knowledge of current accreditation, regulatory and policy requirements.
• Other duties or projects as assigned.

Required Experience:

• A minimum of two years of Payer and Provider credentialing enrollment experience

Knowledge and Skills:

• Knowledge and understanding of the credentialing and enrollment process
• Ability to organize and prioritize work and manage multiple priorities
• Excellent verbal and written communication skills
• Excellent attention to detail
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and credentialing software
• CAQH experience strongly preferred
• MD Staff software experience required

Education/Licensing/Certification:

• Associates degree preferred or appropriate combination of education and experience