What are the responsibilities and job description for the Credentialing Coordinator position at The Orthopedic Institute of Pennsylvania?
Description
SUMMARY OF DUTIES: The Credentialing Coordinator is responsible for coordinating the credentialing, recredentialing, privileging, and payer enrollment processes for physicians and allied health providers at the Ambulatory Surgery Center. This position ensures compliance with accreditation standards, CMS regulations, payer requirements, and organizational policies while maintaining accurate provider records and supporting timely provider onboarding and enrollment.
ESSENTIAL FUNCTIONS:
Coordinate initial credentialing, recredentialing, privileging, and payer enrollment for physicians and allied health providers.
Collect, verify, and maintain credentialing documentation, including licenses, DEA registrations, board certifications, malpractice insurance, and other required credentials.
Perform primary source verification and maintain accurate provider credentialing files.
Prepare credentialing files for Medical Executive Committee and Governing Board review, as applicable.
Complete and submit Medicare, Medicaid, commercial payer, and CAQH enrollment and revalidation applications.
Monitor provider credentialing, enrollment, and licensure expirations; communicate renewal requirements and ensure timely completion.
Serve as the primary liaison with providers, payers, credentialing verification organizations (CVOs), and regulatory agencies to resolve credentialing and enrollment issues.
Ensure compliance with CMS, HIPAA, accreditation standards (AAAHC, Joint Commission, or AAAASF), and organizational policies.
Collaborate with Human Resources, Medical Staff, Compliance, Revenue Cycle, and Leadership to support provider onboarding and maintain credentialing compliance.
Prepare reports, maintain credentialing databases, and assist with regulatory and accreditation audits.
Perform other duties as assigned.
Requirements
EXPERIENCE & EDUCATION:
Minimum 2 years of credentialing experience
Associate degree in Healthcare Administration, Business Administration, or related field preferred.