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About the Role
The Credentialing Coordinator is responsible for managing all aspects of the credentialing and recredentialing process for healthcare professionals within CommUnityCare health centers. This role ensures compliance with regulatory standards and maintains accurate provider information.
Responsibilities
- Reviews, screens, and completes initial credentialing and/or recredentialing applications for completeness, accuracy, and compliance.
- Performs primary source verification (PSV) of all credentialing elements and validates information.
- Enters new applications into the credentialing database.
- Communicates updates and responds to inquiries regarding credentialing and privileging issues.
- Analyzes and resolves discrepancies, time gaps, and other issues impacting credentialing.
- Reports issues to the Credentialing Manager for decision-making.
- Provides follow-up on outstanding credentialing/re-credentialing files.
- Processes provider demographic changes, updates the database, and notifies health plans.
- Prepares and scans credentialing documentation into electronic folders.
- Maintains knowledge of current provider credentialing requirements.
- Ensures compliance with regulatory and accreditation standards, including The Joint Commission and NCQA.
- Monitors and manages credentials/recredentialing renewals to ensure timely collection of required documents.
- Ensures timely entry, processing, and tracking of credentialing files.
- Maintains professional conduct and communication.
- Upholds compliance, confidentiality, and HIPAA guidelines.
- Ensures work is completed in a timely and accurate manner.
- Works within established credentialing timeframes and communicates status and barriers.
- Maintains strong working relationships with providers, health plan staff, and other credentialing offices.
- Develops and maintains favorable internal relationships.
- Monitors licenses and sanctions on a monthly basis.
- Audits disciplinary reports, OIG reports, and initiates formal complaint procedures when applicable.
- Participates in staff meetings and recommends process improvements.
- Responds to emails timely and effectively.
- Provides support to physicians, office staff, and company departments.
- Assists with annual Health Plan delegated credentialing audits.
- Cross-trains within the department to support credentialing operations.
- Participates in required educational/training sessions.
- Performs other job-related duties as assigned.
Requirements
- Ability to function effectively and work under pressure in a demanding and fast-paced environment.
- Ability to manage change, delays, or unexpected events appropriately.
- Demonstrates a sense of urgency and strong time management awareness.
- Strong organizational, problem-solving, and critical thinking skills.
- Proactively prioritizes needs and effectively manages resources.
- Ability to use independent judgment and manage confidential information.
- Ability to function effectively in a remote work environment.
- Ability to work in both individual or group environments and multitask as needed.
Skills
- Articulates knowledge and understanding of organizational policies, procedures, and systems.
- Excellent interpersonal and customer service skills.
- Information research skills.
- Ability to communicate effectively both orally and in writing.
- Proficiency in Microsoft Word, Excel, and Access.
- Knowledge of CAQH (Council for Affordable Quality Healthcare) database and application process.
- Knowledge of Medicare and Medicaid provider enrollment systems.
Location
- Remote
Work Type
- Full-time
Experience Level
- 2 years of experience in practitioner credentialing
Education Level
- High School Diploma
About the Company
- CommUnityCare health centers