Credentialing Coordinator

The Credentialing Coordinator is responsible for verifying, maintaining, and monitoring the credentials of all clinical staff to ensure compliance with state, federal, and organizational requirements. This role plays a critical part in protecting patient safety, maintaining regulatory compliance, and supporting operational excellence by ensuring all credentialing files are accurate, complete, current, and confidential.

• Confirm that all required licenses, certifications, and credentials for staff members are current and valid
• Gather, review, and verify provider credentials including licenses, certifications, education, training, and work history
• Identify discrepancies or gaps in credentialing information and follow up to investigate and resolve issues
• Implement and manage the credential renewal process to ensure timely updates and prevent lapses

• Maintain complete, accurate, and up-to-date credentialing files for all credentialed providers.
• Ensure credentialing documentation is properly stored and data is backed up according to organizational standards
• Preserve strict confidentiality of all employee and provider information

• Ensure credentialing activities comply with applicable state, federal, payer, and organizational requirements
• Prepare credentialing reports for management, committees, and audits as needed
• Respond to external credentialing inquiries from payers, regulatory agencies, and other organizations

• Serve as a point of contact for internal staff, providers, licensing boards, and insurance networks regarding credentialing matters
• Screen credentialing applications and prepare materials for review by credentialing committees

• Exceptional attention to detail and organizational skills
• Strong written and verbal communication abilities
• Effective problem-solving and follow-up skills
• Ability to manage multiple deadlines and priorities

• Working knowledge of healthcare credentialing, regulatory compliance, and verification processes
• Experience with credentialing databases or credentialing software preferred

Required

• High school diploma or equivalent.
• 2–3 years of experience in provider credentialing, provider enrollment, or healthcare administration.
• Strong knowledge of credentialing processes and primary source verification.
• Experience working with health plans, hospitals, and provider networks.
• Proficiency with credentialing software, databases, and online verification systems.
• Excellent attention to detail, organization, and time management skills.
• Strong written and verbal communication skills.

Preferred

• Associate’s or Bachelor’s degree in healthcare administration, business, or a related field.
• Experience with delegated credentialing programs.
• Familiarity with NCQA standards and CMS requirements.
• Credentialing certification (CPCS, CPMSM, or equivalent).

• Competitive compensation
• Supportive, collaborative team environment
• Opportunity to work in a mission-driven healthcare organization
• Professional growth and development opportunities