Credentialing Coordinator

• Support the credentialing process for Trinity Health RHMs
• Assist with documentation
• Maintain accurate physician data
• Participate in process improvements

Credentialing Coordinator supporting Trinity Health RHM credentialing and physician data

Credentialing Coordinator supporting Trinity Health RHM credentialing processes. Maintaining physician data, documentation, and process improvements.

• Processes credentialing and re-credentialing applications
• Monitors Credentialing group inbox
• Researches and resolves participation issues
• Supports financial goals of the company
• Prepares and submits credentialing applications
• Maintains accurate provider records
• Serves as the primary credentialing contact
• Monitors application progress and follows up as needed

Credentialing Coordinator managing healthcare provider applications remotely

Credentialing Coordinator managing credentialing and re-credentialing applications for healthcare providers. Supporting operational readiness and compliance in a remote role.

• Manage the credentialing and re-credentialing processes for physicians, nurses, and allied health professionals.
• Verify licenses, certifications, education, training, and work history to ensure providers are fully qualified.
• Maintain accurate and complete credentialing files, ensuring all staff are cleared before providing care.
• Stay current on federal, state, and accreditation requirements (CMS, Joint Commission, NCQA, etc.).
• Track expiration dates for licensure, certifications, and accreditations to ensure seamless renewals.
• Safeguard provider and facility compliance with healthcare laws and standards at all times.
• Maintain up-to-date credentialing databases and systems.
• Create reports for leadership and regulatory agencies.
• Ensure confidentiality and compliance with HIPAA and other privacy regulations.
• Serve as the go-to contact for providers, accreditation organizations, and external vendors.
• Partner with HR, Medical Staff Services, and leadership to keep credentialing processes on track.
• Provide updates and proactive recommendations on credentialing status and timelines.

Medical Credentialing Coordinator overseeing credentialing processes at Curana Health

Medical Credentialing Coordinator

Medical Credentialing Coordinator ensuring providers meet care and compliance standards at Curana Health. Managing credentialing lifecycle and maintaining regulatory compliance in healthcare settings.

• Responsible for credentialing behavioral health providers (clinicians and facilities) for inclusion in the Lucet provider network
• Work collaboratively with providers, external agencies, and other team members within Network Operations and management staff to promote timely processing
• Research and verify provider credentials, including licensure, education, insurance coverage, and professional background
• Communicate with external agencies and conduct database searches to validate provider qualifications
• Review provider applications for errors and inconsistencies; follow up to obtain required information
• Maintain accurate provider records in credentialing databases
• Prepare and update provider files for presentation to Credentialing Committee meetings
• Support departmental projects and identify opportunities to improve workflows

Credentialing Coordinator managing behavioral health providers at Lucet

Credentialing Coordinator at Lucet overseeing credentialing of behavioral health providers. Collaborating with teams and verifying qualifications for network inclusion.

• Responsible for completion of credentialing functions
• Ensures program integrity and compliance with standards, federal/state requirements, and health plan credentialing requirements
• Maintains relationships with health plan auditors, communicates and works with physician leaders on credentialing issues
• Works with other departments in multiple areas that relate to credentialing issues
• Audits Credentialing Verification Organization's released files to ensure it obtains primary source verification of required physician information
• Maintains database of current and accurate information concerning licensure, board certification, professional liability coverage and claims for physicians, contracted providers and Allied Health Professionals

Credentialing Coordinator at Sutter Health managing credentialing functions and compliance

Credentialing Coordinator at Sutter Health ensuring compliance with standards and health plan requirements. Responsible for credentialing functions and maintaining physician information databases.

• Analyzes and completes the initial and reappointment application approval process by utilizing independent critical thinking skills, which may involve extensive investigative review and interpretation.
• Partners with Medical Staff Leaders to develop policies, evaluation standards and privilege forms based on regulatory changes or hospital service changes serves as the liaison with Board Members, UH Senior Leaders and Administrators.
• Leads and manages provider performance evaluation process in accordance with Regulatory standards and Medical Staff Bylaws to assess clinical competency at initial approval and annually thereafter to monitor trends.
• Participates in all aspects of meeting management, to provide support for Credentials Committee, Medical Executive Committee/Clinical Council, Quality & Professional Affairs Committee, Hospital Board, and all other applicable medical staff meetings.
• Monitors and follows up on the proctoring process for privileges to ensure timely completion and documentation in accordance with credentialing requirements and regulatory standards for quality purposes.
• Manages the Medical Staff elections process, from ballot distribution through certification of results, ensuring adherence to bylaws and communication with Medical Staff leadership.
• Manages the Medical Staff Dues process, including preparing and distributing annual invoices, tracking payments, and maintaining accurate financial records in accordance with Medical Staff Bylaws.
• Collaborates with leadership to update and create new operational procedures as needed to align with industry standard.
• Serves as content expert and participates in onboarding and training of new team members and supports the medical staff with credentialing related projects as aligned with skill set.
• Investigates issues that arise with providers and may involve physicians, UH staff, and/or hospital leadership.
• Manages data quality and integrity for web-based applications based on defined standards through systematic audits.

Medical Staff Services and Credentialing Coordinator overseeing credentialing process

Med Staff, Credentialing Coordinator

Medical Staff Services and Credentialing Coordinator overseeing credentialing process and managing provider performance evaluations. Collaborating with medical staff leadership and ensuring regulatory compliance.

• Manage and submit government (Medicaid) and commercial payer credentialing and revalidation applications
• Proactively communicate with payers regarding application status, documentation needs, and approval timelines
• Maintain accurate, organized credentialing records and supporting documentation
• Partner cross-functionally with Compliance, Legal, Provider Relations, Corporate Development, and Emerging Markets teams
• Obtain and submit insurance certificates, surety bonds, accreditation documentation, and annual filings
• Prepare and process attestations, provider directory verifications, and roster submissions
• Track and process license renewals related to provider enrollment
• Complete CHOW submissions and other payer-specific updates
• Maintain digital credentialing files and submission records
• Process inbound payer communications, including physical mail received in-office

Credentialing Coordinator supporting payer credentialing processes at Aeroflow Health

Credentialing Coordinator at Aeroflow Health ensuring compliance with payer credentialing and licensing. Managing applications and collaborating with cross-functional teams in a hybrid work environment.

• Facilitate the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers
• Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
• Coordinate Credentialing Committee meetings
• Identify and communicate agenda items for Credentialing Committee to immediate leader
• Facilitate prompt coordination with the Credentialing Verification Organization (CVO)
• Review and maintain all applications for accuracy and completeness
• Accurately and efficiently data enter primary source verification data into the credentialing database
• Generate and mail approval letters to participating providers
• Communicate with Network Services regarding status of provider and organizational credentialing

Credentialing Coordinator facilitating Medicaid provider credentialing

Credentialing Coordinator facilitating the credentialing and recredentialing of Medicaid providers for Blue Cross Blue Shield of Arizona. Focused on timely processing and coordination with various departments.

Credentialing Coordinator jobs in United States

See all jobs on JobTailor

Credentialing Coordinator

Credentialing Coordinator

Medical Credentialing Coordinator

Credentialing Coordinator

Credentialing Coordinator

Med Staff, Credentialing Coordinator

Credentialing Coordinator

Credentialing Coordinator