Credentialing Clerk

Our community clinic is looking for a dedicated and detail-oriented individual to join our team as a Credentialing Clerk. In this vital role, you will oversee the credentialing process for our healthcare providers, ensuring adherence to accreditation standards, regulatory requirements, and organizational policies. Your responsibilities will include conducting regular audits, training staff on compliance procedures, and maintaining consistent communication with providers.

If you are passionate about supporting healthcare excellence and ensuring compliance, we would love to hear from you!

The Credentialing Clerk will be an active member of the Compliance Team. Credentialing Clerk is responsible for ensuring that both internal and external health plan credentialing processes are completed in a timely and accurate manner. This role involves maintaining compliance with regulatory standards, verifying provider credentials, and supporting the overall operational efficiency of the organization’s healthcare services. The ideal candidate will possess strong organizational skills, attention to detail, and a commitment to maintaining the highest standards of compliance and quality in healthcare credentialing.

Must be highly proficient in Microsoft Office programs and other computer functions in order to maintain detailed records. The Credentialing Clerk will report directly to the Director of Human Resources and Compliance.

• Associate’s degree or relevant certification required; bachelor’s degree preferred.
• Previous experience in healthcare compliance, credentialing, or a related field is highly desirable.
• Strong attention to detail and organizational skills.
• Excellent verbal and written communication skills.
• Proficient in using Microsoft Office Suite and credentialing software systems.
• Ability to work independently and as part of a team.
• Project management ability from conception to execution and delivery on timeline.

• Assist with the preparation of applications for internal and external credentialing and re-credentialing of healthcare providers.
• Verify provider licenses, certifications, and qualifications through primary source verification.
• Manage the collection and organization of required documentation from providers, including applications, CVs, malpractice history, and any additional required credentials.
• Maintain appropriate documentation of credentialing and re-credentialing activities.
• Coordinate with providers and other external entities on credentialing and re-credentialing matters.
• Track credentialing and re-credentialing activities and ensure timely completion.
• Prepare credentialing and re-credentialing reports and other related materials.
• Educate providers on credentialing and re-credentialing requirements and procedures.
• Monitor and manage all expirable credentialing documents.
• Facilitate the completion of mandatory training for all staff, and coordinate makeup sessions as needed.

• Ensure compliance with all federal, state, and local regulations related to healthcare credentialing.
• Stay up-to-date with changes in credentialing standards and regulations, and communicate relevant changes to appropriate stakeholders.
• Conduct regular audits of credentialing files to ensure accuracy and compliance.

• Collaborate with clinical staff, administrative teams, and external agencies to facilitate the credentialing process.
• Serve as a point of contact for inquiries related to credentialing status, requirements, and processes.
• Prepare and present reports on credentialing activities and compliance status to management and relevant committees.
• Collaborate with the Compliance Department to enhance training initiatives and foster a culture of compliance.

• Maintain accurate and organized records of all credentialing activities, including applications, verification results, and correspondence.
• Utilize electronic health record (EHR) and credentialing software systems to track…