Credentialing Coordinator

Description

Position Summary

We are seeking a Credentialing Coordinator to serve as the primary liaison between our organization and an external credentialing partner.  

While the majority of the initial credentialing process will be managed by the third-party credentialing company, this role will monitor progress and ensure compliance with requirements, maintain provider records, and coordinate communication among stakeholders.

The Credentialing Coordinator will be responsible for monitoring provider enrollment status, tracking recredentialing deadlines, and utilizing our electronic medical record system to manage and update provider enrollment information.  This role will also work closely with our Revenue Cycle and Finance Team to investigate and resolve payer-related claim denials, identify enrollment issues impacting reimbursement, and assist with corrective actions to prevent gaps in reimbursement.

Requirements

Position Responsibilities

• Serve as the primary liaison between Park DuValle Community Health Center and an external credentialing vendor regarding credentialing and enrollment activities. 
• Coordinate the collection of required documentation for provider payor enrollment (Medicaid, Medicare, etc.), and revalidation requests. 
• Track the status of provider payor enrollment and revalidation applications submitted by the credentialing vendor and maintain accurate records. 
• Maintain organized credentialing and payor enrollment files, including application status, supporting documentation, and payer correspondence. 
• Communicate provider updates to include practice location changes, reassignment of benefits, and other required information to the credentialing vendor. 
• Follow up with the credentialing vendor and payers regarding outstanding documentation, application status, or processing delays. 
• Update provider information within the electronic medical record (EMR) and other internal systems as needed. 
• Collaborate with Human Resources to ensure collection of onboarding documentation required for provider credentialing and payor enrollment. 
• Support resolution of credentialing denials, requests for additional information, and revalidation requirements by coordinating with the credentialing vendor and internal departments.
• Monitor credentialing timelines and help ensure required documentation and renewals are completed on schedule. 
• Prepare routine reports and maintain accurate records related to provider credentialing and enrollment activities. 
• Perform other related duties as assigned. 

Benefits & Perks

We offer a competitive and comprehensive benefits package designed to support your health, financial well-being, and professional growth.

• Medical, dental, vision, and life insurance 
• Voluntary benefits, including short-term disability 
• 403(b) retirement plan with employer match up to 5% 
• Paid Time Off (PTO) 
• Eleven paid holidays 
• Predictable work schedule 
• Opportunity to serve diverse and underserved communities 

Park DuValle Community Health Center is an Equal Opportunity Employer and welcomes applications from all qualified individuals.

Minimum Qualifications

• Associate's degree in healthcare administration, Business Administration, or a related field. 
• 2 years of experience in healthcare administration, provider enrollment, credentialing support and billing in a healthcare setting; or an equivalent combination of education and experience. 
• Experience working with healthcare providers, credentialing vendors, or payer organizations. 

Required Skills

• Familiarity with provider credentialing and/or enrollment processes. 
• Exposure to CAQH and healthcare payer systems. 
• Strong organizational skills with the ability to manage multiple priorities and deadlines. 
• Excellent written and verbal communication skills. 
• High attention to detail and accuracy in documentation and data entry. 
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook). 
• Ability to quickly learn credentialing software, payer portals, and electronic medical record (EMR) systems. 
• Strong interpersonal skills and ability to collaborate effectively with providers, vendors, and cross-functional teams. 
• Customer service mindset with strong problem-solving abilities.