Medical Staff Credentialing Coordinator

JOB SUMMARY

The Credentialing Coordinator is responsible for managing and coordinating provider data and payer enrollment processes for healthcare providers within Redefine Management. This role ensures that all provider enrollments are accurate and processed within designated time frames. The coordinator will serve as the main point of contact for all payer and provider inquiries, issue resolution, and escalation as needed.

The Credentialing Coordinator will work closely with internal teams and external stakeholders to facilitate provider onboarding and maintain accurate records.

SUPERVISORY RESPONSIBILITIES:

§ None

DUTIES AND RESPONSIBILITIES:

· Process initial payer enrollment applications for healthcare providers

· Responsible for obtaining all required provider profile documentation

· Complete and submit payer/health plan/IPA participation applications

· Track and document application status, reply to payer and provider inquiries timely and escalate to leadership as needed

· Maintain internal master provider roster database

· Obtain provider rosters from payers

· Audit payer roster/provider directory to ensure all provider data is accurate, submit corrections as needed and track with each payer until complete

· Process all provider demographic updates and follow through with each payer/health plan to ensure accuracy

· Collaborate with internal departments, such as Human Resources and Medical Staff Services, to facilitate provider onboarding and payer enrollment processes.

· Provide support to internal staff on payer enrollment procedures and requirements.

· Main point of contact for all payer/health plan and provider inquires

· Facilitate issue resolution for payers and providers as needed

· Prepare and maintain detailed reports on enrollment status, pending applications, and compliance issues.

· Ensure timely completion of tasks and meet all deadlines for submissions and renewals.

· Compliant tracking and reporting all data / updates / issues as directed

REQUIRED SKILLS, EDUCATION AND EXPERIENCE:

· College degree in Business Administration, or a related field preferred.

· Minimum of [2-4] years of experience in provider/payer enrollment, credentialing or a related field, preferably within a healthcare setting.

· Experience with credentialing software and databases.

· Strong understanding of healthcare credentialing processes, standards, and regulations.

· Excellent organizational and time-management skills.

· Detail-oriented with a high level of accuracy in data entry and documentation.

· Effective communication and interpersonal skills.

· Ability to handle sensitive and confidential information with discretion.

PHYSICAL REQUIREMENTS:

· Office environment with standard working hours.

· Occasional overtime may be required to meet deadlines.

· Ability to work independently and as part of a team.

· Prolonged periods of sitting at a desk and working on a computer.

· Must be able to lift up to 15 pounds at times.

SAFETY PRACTICES:

· Consistently follows all established Safety procedures, incident/accident protocol and precautions or universal precautions when performing duties relating to work area.

· Follows good infection control practices at all times and is familiar with Infection control policies, procedures PPE guidelines and guidance relevant to area of work.

· Practices proper body mechanics and ergonomics at all times.

· Follows established plans, policies and procedures during emergencies, such as fire evacuation, fire drills and actively participates in emergency exercises/disasters etc.

· Reports all Life Safety maintenance issues, defective equipment, etc. through the Environmental Services work order system.

Job Type: Full-time

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• Weekends as needed

Work Location: In person