Senior Credentialing Coordinator

Job Location:

Morgantown Office
- Morgantown, WV, Position Type:
Full Time, Education Level: Bachelor Degree, Salary Range:
Undisclosed,

Job Shift: Day,

JOB TITLE:

Senior Credentialing Coordinator Updated: 10/2026

Administration

Director of Corporate Compliance

Non-Exempt

Monday
- Friday 8:00AM - 5:00PM, Varies

The Credentialing Coordinator reports directly to the Director of Corporate Compliance and manages all agency provider credentialing, payer enrollment, recredentialing, revalidation, and ongoing credential maintenance. The position serves as the central point of accountability for employees, contracted providers, organizational enrollments, and service location affiliations across all Valley Health Care System programs. The coordinator maintains accurate records, completes applications, verifies approvals, tracks deadlines, and resolves enrollment issues in coordination with Human Resources, Finance, Program Supervisors, Billing, and Agency Leadership.

• Manage the complete credentialing lifecycle for all agency providers, including initial credentialing, payer enrollment, recredentialing, revalidation, affiliations, changes, and termination of agency participation.
• Maintain a complete inventory of employees and contracted providers across all programs and locations, including licensed practitioners, nursing staff, non-licensed direct service staff, peer recovery staff, and other roles subject to credentialing or enrollment requirements.
• Maintain role-specific and payer-specific checklists identifying required documents, qualifications, enrollment prerequisites, submission methods, approval steps, and renewal deadlines. Verify applicability rather than assuming all provider categories follow the same process.
• Coordinate credentialing at hire and before role, program, or location changes. Provide individualized packets, review submissions for completeness, obtain missing information, and give providers and supervisors clear due dates and follow-up instructions.
• Collect and maintain applicable licenses, certifications, education and training records, work history, references, liability coverage, identification, disclosure forms, supervision documentation, and other required credentialing records.
• Verify primary source verification as required by the applicable payer through Human Resources. Record the source, verification date, result, expiration date, and reviewer, and resolve any discrepancies before submission.
• Coordinate with Human Resources Department to verify applicable background screening, WV CARES eligibility, APS/CPS screening, and other employment or program clearances. Track and monitor all determinations and renewal dates and promptly elevate missing, adverse, or expired results immediately.
• Perform or reconcile required exclusion and sanction screenings, license status reviews, and other ongoing checks on the established schedule. Retain documentation, resolve potential matches, and immediately report confirmed adverse findings to agency Leadership.
• Coordinate individual and organizational NPI applications and updates, taxonomy selection, and demographic corrections. Validate consistency among source documents, NPPES, payer records, and agency systems.
• Establish and maintain authorized access to credentialing systems and payer portals. Assist providers with CAQH profiles, document uploads, payer access, updates, and timely attestations.
• Prepare, submit, and track applications for WV Medicaid through Gainwell, applicable WV CHIP and Medicaid managed care plans, Medicare, commercial insurers, and other agency payers. Complete each applicable payer process and prerequisite in the required sequence.
• Manage organizational and facility enrollment records, group affiliations, service location additions, demographic changes, and supporting documents. Coordinate W-9s, licenses, insurance certificates, accreditation records, ownership disclosures, and authorized signatures with responsible departments.
• Prepare and validate payer rosters and bulk uploads. Confirm provider identifiers, credentials, roles, agency tax identification numbers, organizational NPIs, and authorized service locations before submission.
• Track submission dates, reference numbers, outstanding requests, follow-up dates, aging, approvals, denials, and effective dates. Monitor portal messages and correspondence, respond within applicable deadlines, and pursue stalled applications…