Credentialing Coordinator

About the role

We are seeking a detail-oriented and organized Credentialing Coordinator to join our Credentialing team. In this full-time remote role, you will coordinate and monitor payer enrollment, re-credentialing, and revalidation activities for physician groups while ensuring provider information and required documentation remain accurate and up to date. The Credentialing Coordinator will also support department training and client onboarding, maintain credentialing records and contracts, and work closely with internal teams and assigned clients to ensure a smooth provider enrollment and billing process.

Responsibilities

• Complete provider payer enrollment, re-credentialing, and revalidation applications.
• Monitor provider and organization enrollment applications and follow up as needed.
• Maintain confidentiality of provider information.
• Perform and maintain primary-source verification of current medical licenses, DEA registrations, and board certifications.
• Maintain current physician group licenses, ACR certifications, and other documentation required for enrollment.
• Maintain provider malpractice insurance and educational documentation.
• Maintain provider contract files, including requesting contracts and coordinating with clients regarding terms and conditions.
• Maintain copies of fully executed client contracts.
• Manage and maintain tickets within the Credentialing Department ticketing system.
• Communicate efficiently and effectively with assigned clients.
• Collaborate with internal departments, including Client Service, to coordinate provider enrollment activities and billing.
• Assist with department training and client onboarding.
• Maintain accurate provider demographics and assigned physician group information within CredentialStream.
• Process enrollments and utilize CredentialStream workflows for provider enrollment.
• Prepare reports and documentation as needed.
• Perform other related duties as required.

Requirements

• High school diploma or equivalent.
• Minimum of two years of relevant experience or CPMSM/Certified Provider Credential Specialist certification preferred.
• Above-average knowledge of basic medical billing and insurance carriers.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Excel.
• Ability to research, analyze and interpret information and prepare accurate reports and documentation.
• Ability to manage confidential information with discretion.
• Strong attention to detail, organization and follow-through.
• Physical requirements: prolonged periods of sitting at a desk and working on a computer; ability to lift up to 15 pounds occasionally.

Skills

• CPMSM or Certified Provider Credential Specialist certification.
• Experience with payer enrollment, credentialing, re-credentialing or healthcare administration.
• Experience working with credentialing software, particularly CredentialStream.