Credentialing Coordinator

Location:

Remote Position Hiring Range: $16.00 - $30.21

POSITION SUMMARY Processes credentialing and re-credentialing applications of health care practitioners/providers. Monitors Credentialing group inbox to ensure all emails are addressed. Researches and solves participation issues as they arise. Supports the financial goals of the company by being fiscally responsible in all areas, including staffing and purchasing.

KPA 1 – Credentialing & Provider Enrollment Management Coordinate and process initial credentialing, re-credentialing, enrollment, reenrollment, provider updates, and reappointments with commercial payers, government agencies, hospitals, and licensing entities. Prepare, review, and submit credentialing applications accurately, ensuring completeness and compliance with payer, regulatory, accreditation, and organizational requirements. Manage provider participation to support timely onboarding and uninterrupted network participation.

KPA 2 – Provider Data Integrity & Compliance Maintain accurate provider records within credentialing systems, CAQH, payer portals, and related databases. Obtain, verify, and maintain all required credentialing documentation, including licenses, certifications, board certifications, malpractice coverage, DEA registrations, and curriculum vitae. Monitor licensure, certifications, insurance, and credential expiration dates to ensure continuous compliance and prevent lapses in participation. Maintain audit-ready files and support accreditation surveys, delegated credentialing activities, and regulatory compliance reviews.

KPA 3 – Credentialing Coordination & Stakeholder Support Serve as the primary credentialing contact for assigned providers, payers, hospitals, and internal departments. Monitor application progress, confirm receipt and submission, and proactively follow up with external organizations to meet established turnaround times. Collaborate with Provider Relations, Operations, Revenue Cycle, Billing, Compliance, and leadership to support provider onboarding and operational readiness. Monitor the Credentialing team inbox to ensure timely response to provider, payer, and internal inquiries.

KPA 4 – Issue Resolution & Operational Support Research, investigate, and resolve credentialing, enrollment, provider participation, and demographic discrepancies to minimize delays. Escalate credentialing issues, denials, missing documentation, provider non-responsiveness, and other risks impacting participation or reimbursement. Support departmental initiatives and perform additional credentialing and provider data management responsibilities as assigned.

KPA 5 – Reporting, Performance & Process Improvement Maintain complete documentation of credentialing activities and communications within designated tracking systems. Generate credentialing status reports, aging reports, productivity metrics, and other operational reports. Prioritize a high-volume workload while meeting quality, productivity, and turnaround standards. Participate in workflow improvements, departmental projects, and process enhancement initiatives to improve efficiency and service delivery. Maintain current knowledge of credentialing standards, payer requirements, regulatory updates, and industry best practices.

KPA 6 – Financial Stewardship Support organizational financial objectives by ensuring efficient credentialing operations that minimize reimbursement delays and provider participation interruptions. Demonstrate fiscal responsibility through effective resource utilization and adherence to departmental budget and purchasing practices.

Position Qualifications Education High school diploma or GED required.

Minimum Relevant Experience Minimum of 2 years of credentialing experience with…