Healthcare Credentialing Coordinator

Job Summary

A Provider Credentialing Specialist is responsible for managing the end-to-end credentialing and recredentialing process for healthcare providers. This includes collecting and verifying essential documentation such as licenses, certifications, and work history, and ensuring compliance with regulatory standards (e.g., NCQA, CMS, Joint Commission). The specialist works closely with insurance companies—including Medicare and Medicaid—to complete credentialing applications, navigate payer-specific portals, and monitor enrollment status. Strong attention to detail, knowledge of credentialing databases (such as CAQH or Availity), and the ability to manage multiple deadlines are essential for success in this role.

Key Responsibilities:

• Credentialing & Recredentialing:
• Coordinate and manage the initial credentialing and recredentialing process for healthcare providers, including physicians, nurse practitioners, and allied health professionals.
• Collect, verify, and maintain provider documentation such as state licenses, DEA certificates, board certifications, malpractice insurance, education, and work history.
• Insurance Enrollment & Payer Communication:
• Prepare and submit applications for provider enrollment with insurance companies, including commercial payers, Medicare, Medicaid, and managed care organizations.
• Communicate with payer representatives to follow up on application status, resolve issues, and ensure timely processing.
• Stay up to date on enrollment guidelines, payer policies, and requirements for each insurance plan.
• Portal & Database Management:
• Navigate and manage multiple online credentialing and enrollment portals (e.g., PECOS for Medicare, CAQH, Availity, payer-specific systems).
• Update and maintain accurate provider profiles in credentialing databases and internal systems.
• Ensure provider records are current, complete, and compliant with both internal standards and external regulations.
• Compliance & Regulatory Adherence:
• Ensure all credentialing activities align with regulatory standards including CMS, NCQA, URAC, and Joint Commission.
• Monitor and track license renewals, recredentialing deadlines, and expiring documents to avoid lapses in participation or compliance.
• Assist with internal and external audits by preparing documentation and responding to audit requests.
• Communication & Coordination:
• Serve as a liaison between providers, payers, internal departments (e.g., HR, Medical Staff Office, Billing), and credentialing committees.
• Educate providers on credentialing requirements and assist with completing forms or gathering necessary documents.
• Communicate updates and status reports to leadership as needed.
• Reporting & Process Improvement:
• Generate regular status reports, credentialing summaries, and application tracking logs.
• Contribute to improving credentialing workflows, identifying inefficiencies, and recommending solutions to enhance accuracy and turnaround time.

Skills

• Proficient understanding of medical terminology and standards relevant to healthcare credentialing.
• Strong organizational skills with attention to detail to manage multiple tasks effectively.
• Excellent communication skills, both verbal and written, for interaction with healthcare providers and staff.
• Familiarity with managed care processes and requirements is highly desirable.
• Ability to work independently as well as collaboratively within a team environment.
• Proficient in using credentialing software and Microsoft Office Suite applications.

. If you are detail-oriented, organized, and passionate about supporting quality healthcare delivery, we encourage you to apply for this rewarding position as a Credentialing Specialist.

Job Type: Part-time

Pay: From $22.00 per hour

Expected hours: 10 – 20 per week

Work Location: Hybrid remote in Mars, PA 16046

Salary : $22