Credentialing Coordinator

Position Summary

The Credentialing Coordinator is responsible for managing and maintaining the credentialing and re-credentialing process for healthcare providers, interns/students/residents and volunteers to ensure compliance with regulatory standards, accreditation requirements, and organizational policies. This role ensures that all WellPower Medical Staff meet the qualifications and maintain active status with insurance networks and governing bodies while also developing and maintaining a working knowledge of relevant statues and laws.

Compensation & Benefits

• $57,803.20 - $80,995.20 per year
• For complete overview of our robust Benefits: https://wellpower.org/workplace-of-choice/
• The posted range represents the full hiring range. Offers will not exceed this range, the majority of candidates are placed near the midpoint based on experience and qualifications.

Job Duties & Functions

• Collect, verify, and process provider documentation including but not limited to licenses, certifications, education, work history, and malpractice history.
• Submit applications to insurance payers and monitor approval status.
• Maintain accurate and up-to-date credentialing files in compliance with NCQA, HRSA, CMS, and state regulations.
• Ensure adherence to organizational policies, federal and state regulations, and accreditation standards.
• Track expiration dates for licenses, certifications, and other credentials; notify providers of upcoming renewals.
• Verify all renewal information and update the provider credentialing file
• Maintain credentialing database and provider records with high accuracy.
• Generate reports for leadership and assist with audits as needed.
• Maintain CAQH and NPI profiles for providers
• Serve as a liaison between providers, insurance companies, and internal departments.
• Perform other duties as assigned
• Maintain a trauma informed environment of wellbeing.
• Other duties as assigned

Requirements & Qualifications

• High School Diploma or GED.
• 2+ years of medical credentialing and /or provider enrollment experience
• Associate's degree in healthcare administration, business, or relevant work preferred

Work Location

This is a hybrid opportunity open to folks residing in the Greater Denver Metro area.

Shift/Hours

This is a Monday-Friday opportunity observing standard business hours.

Physical Requirements

Requires sitting, standing, bending and reaching. May require lifting up to 20 pounds. Requires manual dexterity sufficient to operate standard office machines such as computers, fax machines, the telephone and other office and/or clinical equipment.

Working Conditions

This is a full-time, hybrid position with a standard schedule of Monday through Friday during regular business hours. The role includes a combination of remote work and on-site presence at the organization's main office, as needed to support credentialing activities, meetings, and events.