Credentialing Coordinator

The Credentialing Coordinator is responsible for managing and maintaining provider credentialing and recredentialing processes in compliance with regulatory, accreditation, and payer requirements. This role ensures that healthcare providers are properly credentialed, enrolled, and continuously monitored to support timely reimbursement and regulatory compliance. The position requires strong attention to detail, organization, and communication skills while working independently in a remote environment.

Key Responsibilities

Manage end-to-end provider credentialing, recredentialing, and enrollment processes with insurance payers, hospitals, and other healthcare entities

Prepare, submit, and track credentialing and enrollment applications to ensure timely approvals

Verify provider qualifications, including licenses, certifications, education, training, work history, and malpractice insurance

Maintain accurate and up-to-date provider files in credentialing databases and electronic systems

Monitor credentialing expirations and proactively initiate recredentialing to prevent lapses

Ensure compliance with federal, state, payer, and accreditation standards (e.g., NCQA, CMS, URAC, Joint Commission)

Communicate with providers, payers, and internal teams to resolve credentialing issues and follow up on application status

Audit credentialing files for accuracy and completeness

Assist with provider onboarding and offboarding processes

Generate reports related to credentialing status, expirations, and compliance metrics

Maintain confidentiality and data security in accordance with HIPAA and organizational policies

Qualifications

High school diploma or equivalent required; associate or bachelors degree preferred

1–3+ years of experience in healthcare credentialing, provider enrollment, or medical administration preferred

Knowledge of payer enrollment processes and credentialing standards

Familiarity with credentialing software and databases (e.g., CAQH, PECOS, NPPES, or similar systems)

Strong organizational, analytical, and time-management skills

Excellent written and verbal communication skills

Ability to work independently and manage multiple deadlines in a remote setting

Preferred Skills

Experience working remotely in a healthcare administrative role

Understanding of medical terminology and healthcare regulations

Proficiency in Microsoft Office or Google Workspace

Detail-oriented with strong problem-solving abilities