Credentialing Coordinator [AQ-11526]

About the role

This role is with a leading healthcare organization dedicated to ensuring the highest standards of quality and compliance within its provider networks. As a vital team member, you will be instrumental in upholding rigorous standards for all clinicians, allowing them to remain active and provide essential services.

Key Responsibilities

• Ensure strict compliance with industry regulations and client requirements, including NCQA, URAC, Medicare, Medicaid, and various state and federal guidelines.
• Continuously verify state licenses, exclusion lists, DEA registrations, and Board Certifications to maintain an active and qualified clinician network.
• Facilitate the enrollment of clinicians in Medicare and Medicaid programs, adhering to all state and federal guidelines.
• Manage the application process for state licensure for clinicians, ensuring timely and accurate submissions.
• Cultivate strong collaborative relationships with internal teams, including Recruiting, Production, and Education departments.
• Monitor and review clinician files for completeness and accuracy, ensuring all documentation meets quality standards and accreditation requirements.
• Prepare and deliver essential information to both internal and external stakeholders as needed.
• Accurately enter, update, and maintain provider application data within the credentialing database, ensuring data integrity and adherence to internal policies.
• Efficiently manage the high-volume processing of individual applications by preparing, issuing, electronically tracking, and following up on appropriate verifications within strict timelines.
• Communicate clearly and professionally with providers, internal/external clients, and all staff to address day-to-day credentialing inquiries promptly.
• Engage in continuous professional development through seminars, workshops, and affiliations to stay current with healthcare regulations and industry advancements, and contribute to special projects.

Qualifications

• Demonstrated ability to verify licensure and education accurately.
• Proven experience in completing and processing applications.
• Exceptional attention to detail and strong administrative skills.
• Highly preferred experience (1-3 years) in credentialing or licensure.
• Must be authorized to work in the United States.
• Must not require sponsorship of any kind for the duration of the assignment.
• Must be able to work on a W-2 basis. C2C or 1099 is not permitted for this position.

Skills

• NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) — preferred.
• Experience with CAQH — preferred.
• Experience with MD Staff — preferred.
• Proficiency in Google Suite — preferred.

Pay

The target hiring compensation range for this role is $16.38 – $18.20 an hour. Compensation is based on several factors, including but not limited to education, relevant work experience, relevant certifications, and location.