Credentialing Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Process applications for credentialing and re-credentialing of healthcare practitioners/providers.

• Oversee the Credentialing group inbox, responding to inquiries from providers, payers, and internal teams.

• Facilitate the credentialing, enrollment, re-enrollment, provider updates, and reappointments with payers, government agencies, hospitals, and licensing authorities.

• Prepare, review, and submit thorough and compliant credentialing applications.

• Manage provider participation to ensure timely onboarding and continuous network involvement.

• Keep precise provider records in credentialing systems, CAQH, payer portals, and associated databases.

• Acquire, verify, and maintain licenses, certifications, board certifications, malpractice insurance, DEA registrations, and curricula vitae.

• Monitor credential and insurance expiration dates to avert participation interruptions.

• Maintain audit-ready files and assist with accreditation surveys, delegated credentialing, and regulatory assessments.

• Act as the main credentialing contact for designated providers, payers, hospitals, and internal departments.

• Track application progress and follow up with external entities to meet turnaround expectations.

• Collaborate with Provider Relations, Operations, Revenue Cycle, Billing, Compliance, and leadership teams.

• Investigate and resolve discrepancies related to credentialing, enrollment, participation, and demographics.

• Escalate issues such as denials, missing documentation, provider non-responsiveness, and other risks related to participation or reimbursement.

• Maintain records and generate reports on credentialing status, aging, productivity, and operational performance.

• Prioritize a high-volume workload while adhering to quality, productivity, and turnaround benchmarks.

• Engage in workflow enhancements, departmental projects, and process improvement initiatives.

• Stay updated on credentialing standards, payer requirements, regulatory changes, and best practices in the industry.

• Contribute to financial goals through efficient credentialing operations and prudent resource management.

⛳️ Requirements

• High school diploma or GED is mandatory.

• A minimum of 2 years of credentialing experience is preferred.

• Strong understanding of provider credentialing, enrollment, and recredentialing processes is preferred.

• A valid state driver's license is required for travel to satellite offices and off-site meetings.

• Must adhere to the organization's Driver Safety Operations and Motor Vehicle Records Check Policy.

• Excellent analytical, critical thinking, problem-solving, decision-making, planning, organizational, and time management abilities.

• High attention to detail and strong independent judgment.

• Exceptional interpersonal skills, emotional intelligence, diplomacy, tact, conflict resolution, and professionalism.

• Capability to maintain confidentiality and handle sensitive information.

• Strong verbal and written communication skills.

• Ability to cultivate collaborative relationships with providers, leadership, and cross-functional teams.

• Skill in prioritizing multiple assignments and managing competing deadlines.

• Ability to work independently with minimal supervision, including in a remote setting when necessary.

• Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook.

• Familiarity with credentialing software, provider databases, and credentialing workflows is preferred.

• Adaptability to shifting priorities while maintaining quality, accuracy, and operational efficiency.

• Travel requirement of 0–25%.

🏝️ Benefits

• Comprehensive health insurance with an extensive provider network.

• 401k plan with a 100% match and various investment options.

• Generous Paid Time Off (PTO) program.

• Flexible work arrangements.

• Annual summits for collaboration with AON peers.

• Opportunities for professional development.

• Tuition assistance available.

• Flexible working hours.

• Guidance for ergonomic home office setup.

• Access to communication software.