At the direction of the Corporate Director of Quality Performance, the Credentialing Coordinator has
primary responsibility for the day-to-day functioning of the Credentialing Services Department.
Job Duties and Responsibilities:
Responsibilities include, but are not limited to:
Preparation and submission of provider credentialing applications to government entities, private
health insurance companies and managed care organizations.
Preparation and submission of physician and allied health provider credentialing applications to
hospitals and ancillary health facilities for purposes of obtaining staff privileges.
Management of all provider files for maintenance of timely submission of updated licensure,
CME and other documentation as may be required for recredentialing to managed care
organizations or reappointment for facility privileges.
The Credentialing Coordinator is responsible for the maintenance and integrity of highly confidential
personal and professional information for client providers. Such information is protected discovery by
applicable state and federal statutes.
Credentialing Coordinator shall interface with internal and external constituencies involved with
and impacted by the accurate and timely completion of all credentialing services activity.
Interaction may include regular communication with providers, provider contracting consultants,
office managers, and medical staff credentialing coordinators at various hospitals. In certain
project settings, communication may also occur with account managers, sales and operational
staff, and provider relations representatives.
Credentialing Coordinator shall participate in various staff meetings, as may be scheduled by
clients or company management. The Credentialing Coordinator may participate in client
meetings to assist with implementation planning processes associated with activation of a new
Credentialing Coordinator may be asked to participate in other projects in support of the
organization, and will perform other tasks as they may be assigned from time to time.
Industry Background and Communication Skills:
Candidate shall possess excellent communication skills, and have a strong knowledge of the laws,
regulations, rules and industry practices related to health care operations and physician credentialing in
particular. The Candidate shall have a demonstrated ability to work in a self-directed manner, with
minimal supervision. The Candidate must possess the ability to efficiently prioritize work according to
level of urgency, and to communicate with team members about any issues impacting the completion of
tasks within the scheduled timeframe for delivery. The Candidate will have an ability to remain focused
on priorities in a busy environment with the potential for multiple interruptions throughout the course of
the workday, to successfully manage multiple tasks simultaneously, and meet deadlines and productivity
Candidate shall demonstrate a facility for teamwork and the ability to interface comfortably across all
levels within a health services organization. Interactions with physicians and their office staff, hospital
staff members and management, and all levels of staff within the organization will be a routine aspect of
position duties. Proficiency in professional customer service protocols is essential. Familiarity with
medical terminology, medical insurance terminology, and medical billing procedures, is preferred.
Candidate shall demonstrate a high level of proficiency in the utilization of common office software
applications (Word, Excel, PowerPoint, etc.), as well as accuracy in keyboarding skills. Proficiency in
Advanced Excel skills (Pivot Tables, V:Lookups) to support creation of spreadsheets for both analysis and
management reporting is highly preferred, as is familiarity and experience with CRM programs such as
Education or Equivalent Experience Required:
Bachelors, High School diploma, or equivalent related work experience. A minimum of 3-5 years’
experience in the health care services industry is desirable but not required. The candidate must possess a
strong knowledge of and practical experience with process management and operational prioritization