Reference :
Credentialing Coordinator
Category :
Contract :
Direct Hire
Job(s) available(s) :
Experience :
1-2 years
Studies level :
Wage :
$20-$26 / hr
Working place :

 Job Description/Summary: 

Identify, obtain and verify credentials for all licensed practitioners for initial credentialing and re-credentialing under the direction of the Provider Relations Coordinator. Prepare credential files for presentation to the Membership Committee and the Board of Trustees. Maintain electronic and hard-copy files to ensure all credentials are current.

 Essential Duties and Responsibilities:

  • Respond to requests for membership by sending out the appropriate membership packets.
  • Process initial applications as received, verify education, training, hospital affiliations, peers’ letters of recommendation, board certification, licensure, national practitioner data bank (NPDB) and Medicare/Medical sanction information.
  • Reviews packets and documentation for accuracy, follows up to obtain missing or incomplete items in a timely and professional manner.
  • Process re-applications for providers due for re-credentialing every three (3) years.
  • Ensure licensure for all practitioners is current at all times in the files. Proactively verifies licensure with the Licensing Boards for new credentialing applications, re-credentialing, upon sanctioning and additionally as needed.
  • Prepare credentialing packets as needed for the Membership Committee.
  • Create and maintain hard copy and computer files to ensure most current practitioner data is available.
  • Identify need, develop, implement and maintain credentialing/re-credentialing reports.
  • Prepare and distribute monthly physician rosters to designated individuals internally and externally as directed.
  • Responsible for following Company, client policies and procedures, HIPAA and other regulatory guidelines in the handling of Personal Health Information (PHI).
  • Responsible for regular and predictable on-site attendance.
  • Perform related duties as required as assigned.
  • Ensure work areas are clean, organized and policyholder information is kept secure.
  • Attend meetings and training as necessary.
  • Work in a team environment, ensuring team and individual goals are met.
  • Handle special projects and duties as assigned.

 Knowledge, Skills and Abilities required:

  • Must be a self-directed individual who possesses high level organizational and time management skills.
  • Strong analytical skills and demonstrates excellent attention to detail.
  • Ability to communicate in a professional manner, possesses excellent oral, business writing and telephone skills.
  • Ability to follow instructions and follow established departmental protocols and procedures.
  • Ability to maintain professional demeanor, exercises tact and discretion. Highly ethical and maintains high level of confidentiality.
  • Proficient in Microsoft Office applications including Word, PowerPoint, Outlook and Advanced Excel skills.
  • Working knowledge client software and internal report-generating programs.
  • Experience in meeting NCQA standards.
  • Must be able to establish and maintain effective interpersonal skills with all Foundation staff, telephone and walk-in clientele.
  • Ability to conform to an established work schedule and demonstrate high-level attendance in accordance with the Attendance/Absenteeism Policy.

 Minimum Education and/or Experience, Certifications/Licenses required:

  • Two years’ experience in the field of Health Care Credentialing,
  • Knowledge of Medical Terminology preferred.
  • Typing certificate verifying ability to type a minimum 40 words per minute dated within one year of application date.

Essential Physical Requirements and Tasks:

  • Employee is constantly required to sit; talk; hear; use keyboard/ten key; and repetitive motion of hands.
  • Employee is occasionally required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; and stoop, bend, kneel, squat or crouch.
  • The employee must occasionally lift and/or push/pull up to 25 lbs.
  • Specific vision abilities required by this job include close vision, distance vision and depth perception.
  • Exposure to air-conditioned/heated office environment.
  • Work in close proximity to others and experience low noise levels from office equipment and voices.
  • Use of office equipment, such as telephone, computer, copy machine and fax machine.

Laura Hill, CEO / Executive Recruiter | 661-340-5099 | This email address is being protected from spambots. You need JavaScript enabled to view it.