Credentialing Coordinator

About the role

Select Medical is seeking a Credentialing Coordinator to support the Credentialing Manager with credentialing and re-credentialing processes for providers across outpatient facilities. This role ensures compliance, accuracy, and smooth onboarding of practitioners.

Responsibilities

• Conducts credentialing and re-credentialing in compliance with NCQA and HIPAA standards for internal and external clinicians.
• Researches and obtains verifications of practitioners’ credentials to meet internal and external credentialing requirements.
• Manages state-specific credentialing activities for providers in outpatient facilities.
• Prepares and processes all credentialing documentation.
• Updates and maintains current and accurate practitioner files and databases.
• Tracks and reports practitioner changes to appropriate parties.
• Communicates with practitioners, data banks, state licensing and regulatory bodies, educational programs, health plans, and other company divisions.
• Collaborates with health plans to provide practitioner credentialing documentation as required.
• Participates in activities associated with health plan site audits and Credentialing Committee meetings.
• Coordinates training and educational requirements for credentialing staff.
• Provides routine updates and status reports for health plans and other divisions within the company.
• Maintains confidentiality of practitioner information.
• Collaborates with team members to support process improvement and the development of policies and procedures.
• Participates in the development and coordination of departmental CQI initiatives.
• Troubleshoots with internal business operations and Managed Care contracting to resolve accounts receivable delays due to credentialing issues.
• Performs other duties as assigned.

Requirements

• At least 2 years of experience in provider credentialing or other related healthcare field.
• Proficient in Windows (Word, Excel, and Access).
• Ability to be professionally assertive with internal and external partners to be influential in finding resolutions.
• Strong oral and written communication skills with the ability to interact professionally and positively within all levels of the organization.
• Detail-oriented with good organizational skills and the ability to maintain accuracy while meeting deadlines and production requirements.
• Excellent interpersonal skills and commitment to quality improvement.
• Professional with the ability to work well independently as well as collaboratively with a team.

Qualifications

• Prior credentialing experience.
• Knowledge of credentialing processes, terminology, and NCQA standards.
• Strong analytical skills, including process improvement and problem resolution.