Credentialing Coordinator

Remote

The Credentialing Coordinator is responsible for the day-to-day operational execution of our provider credentialing and re-credentialing processes, helping ensure our provider network remains compliant and audit ready.

In this role, you will support initial credentialing, re-credentialing, primary source verification, payer and delegated credentialing workflows, and licensing. You will be a key member of the medical group operations team and partner with cross-functional operations team members, compliance, and quality team stakeholders to complete credentialing files accurately, efficiently, and in alignment with NCQA standards, payer requirements, and medical group policies and procedures.

The ideal candidate is a strong doer with an analytical mindset who is comfortable working in the details, following established processes, identifying issues, and helping drive timely resolution. This role is best suited for someone who enjoys executing credentialing operations at a high level, with an eye for efficiency.

• Execute day-to-day credentialing and re-credentialing work in support of our provider network, ensuring timely, accurate, and compliant completion of assigned deliverables
• Process initial credentialing and re-credentialing applications by reviewing provider files against NCQA standards, payer requirements, and internal guidelines
• Perform primary source verification, including but not limited to licensure, board certification, education, work history, malpractice history, and sanctions checks
• Execute supporting tasks related to delegated credentialing audits and payer credentialing submissions
• Partner closely with the credentialing team members to help manage caseload, meet turnaround times, and maintain file quality
• Collaborate with provider relations, licensing, compliance, and network operations partners to resolve questions, issues, escalations, and delays
• Review provider data, applications, and supporting documentation to identify discrepancies, expirables, or items requiring follow-up
• Document findings clearly in the credentialing database and escalates non-standard situations when appropriate
• Follow established policies, procedures, and workflows while maintaininga high level of detail and accuracy in preparation for internal and external audits

• Diploma, or a related field, or equivalent relevant experience
• 3+ years of experience in provider credentialing, medical staff services, healthcare operations, or a related operational role
• Working knowledge of NCQA credentialing standards and primary source verification requirements
• Familiarity with provider licensure requirements across multiple states
• Strong analytical and problem-solving skills, with the ability to review detailed information and make sound decisions
• Highly organized and detail-oriented, with the ability to manage multiple tasks and priorities
• Comfortable working independently and as part of a team, with minimal direct supervision
• Results-oriented, with experience meeting productivity, quality, and turnaround expectations
• Excellent interpersonal and communication skills; willingness to ask questions, speak up, and seek clarity when needed
• Comfortable in a fast-paced and evolving organization with a willingness to be flexible and support urgent operational needs

• Experience with NCQA delegated credentialing audits or payer-specific credentialing requirements
• Familiarity with credentialing databases or platforms (e.g., Verifiable, Availity, CAQH, etc)
• Experience working with health plans, hospitals, or delegated credentialing entities
• Experience supporting NCQA accreditation preparation or audit readiness