Credentialing Coordinator

Job Objective: The Credentialing Coordinator is responsible for executing and supporting all activities related to provider credentialing, privileging, payer enrollment, and regulatory compliance. This role ensures accuracy, timeliness, and completeness of provider files and acts as an essential team member in maintaining compliance with internal policies, hospital medical staff bylaws, state/federal regulations, and accreditation standards.

Key Responsibilities

Credentialing & Privileging

• Process credentialing and privileging applications for all medical providers.

• Complete primary source verifications in accordance with organizational policies and accreditation standards.

• Maintain credentialing files, ensuring accuracy, organization, and audit readiness.

• Track and monitor expiring licenses, certifications, and required documents.

• Support hospital privileging processes, including privilege form preparation, submission, and status tracking.

• Respond to requests for information from hospitals, payers, and regulatory entities.

Payer Enrollment

• Submit and track payer enrollment applications for government and commercial payers.

• Update provider demographics in payer portals and internal systems.

• Assist with revalidation and renewal requirements to maintain continuous enrollment.

Provider Onboarding Support

• Assist with gathering required documents during onboarding.

• Coordinate completion of credentialing-related onboarding tasks, including background checks, verifications, attestations, and required forms.

• Collaborate with HR, Operations, and IT to support timely provider start dates.

• Provide updates on credentialing and enrollment progress to internal stakeholders.

Data Management & Systems

• Maintain provider information in credentialing database and other systems as appropriate.

• Ensure data integrity, accuracy, and consistency across internal tools and rosters.

• Generate reports as needed for leadership, compliance reviews, and operational planning.

Compliance & Quality

• Maintain compliance with AAAHC, CMS, NCQA, OIG, and state regulatory requirements.

• Participate in periodic audits of credentialing files.

• Ensure confidentiality and secure handling of sensitive provider information.

• Support continuous improvement of credentialing and enrollment workflows.

Communication & Team Collaboration

• Communicate professionally with providers, internal departments, hospitals, and payers.

• Assist team members by answering questions and supporting cross-coverage needs.

• Escalate issues appropriately to the Lead Credentialing Coordinator or Director.

Education & Experience

• High school diploma required. Associate's degree preferred.

• Experience in credentialing, payer enrollment, or healthcare administration preferred.

• Experience working with credentialing software and healthcare database is preferred.

Skills & Competencies

• Strong attention to detail with high accuracy.

• Excellent organizational and time-management skills.

• Ability to prioritize and manage multiple tasks in a deadline-driven environment.

• Strong written and verbal communication skills.

• Proficiency in Microsoft 365, Adobe Pro, and credentialing software.

• Ability to interpret regulatory guidelines and follow established procedures.

• Professionalism, confidentiality, and strong customer service orientation.

Physical Demands

• Ability to sit, stand, walk, bend, and use a computer for extended periods.

• Ability to communicate in person, by phone, and through virtual platforms.

Working Environment

• Hybrid or onsite depending on organizational needs.

• Occasional travel between locations may be required.

• Occasional after-hours work during high-volume periods

Equal Opportunity Employer

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