Credentialing Coordinator

Position Overview:

The Credentialing Coordinator supports the Credentialing Manager in the implementation of the organization's credentialing, re-credentialing, and provider enrollment functions. This role is responsible for executing day-to-day credentialing and enrollment activities, maintaining accurate records, and ensuring timely processing of provider information in accordance with organizational policies and regulatory requirements. This work is carried out in support of the mission and goals of Ryan Health.

Essential Functions:

Credentialing of New Providers

• Upon notification by Human Resources (HR) of a new hire, initiate credentialing process, including distribution of credentialing packets and applications.
• Track and follow up with providers to ensure timely submission of complete credentialing materials.
• Perform primary source verification of licenses, certifications, and other required documentation in accordance with credentialing policies.
• Assist in preparation of delineation of privileges (DOP) documentation.
• Compile and organize credentialing files for review by the Credentialing Manager and Medical Director.
• Support preparation of materials for Credentials Committee review, including assembling files and tracking status.
• Assist with scheduling of Credentials Committee meetings and preparation of draft minutes, as directed.
• Provider enrollment.
• Support enrollment of providers with Medicaid, Medicare, managed care organizations, and commercial payors.
• Prepare and submit enrollment applications and supporting documentation under direction of the Credentialing Manager.
• Track application status and follow up with payors to ensure timely processing.
• Maintain documentation related to delegated credentialing arrangements, as applicable.

Re-credentialing and Maintenance

• Monitor re-credentialing timelines and notify providers of upcoming requirements.
• Assist with collection and review of re-credentialing materials.
• Prepare re-credentialing files for internal review and committee submission.
• Support resolution of routine enrollment and credentialing issues, escalating more complex matters to the Credentialing Manager.

Third-Party and Regulatory Submissions

• Create and update provider profiles in CAQH and other required databases.
• Assist with Medicaid and Medicare enrollment and revalidation submissions.
• Maintain accurate NPI and provider data across systems.
• Support provider enrollment in NCQA/PCMH systems, 340B program, and other third-party platforms as directed.

Reporting, Documentation & Systems

• Maintain credentialing records and files in accordance with Joint Commission, NCQA, and CAQH standards.
• Enter and update provider data in credentialing software systems.
• Assist in preparation of routine reports on credentialing and enrollment activity.
• Ensure data accuracy and completeness across all tracking tools and systems.

Policies, Procedures & Compliance

• Adhere to organizational credentialing policies and applicable regulatory requirements.
• Support audit preparation and responses for internal and external reviews (e.g., HRSA, Joint Commission).
• Maintain confidentiality and security of provider information.
• Participate in special projects and perform other duties as assigned in support of the Credentialing function.

Minimum Experience and Skills Required:

• 0-2 years of credentialing, provider enrollment, or related healthcare administrative experience; relevant experience in a health center or similar clinical setting in another capacity will be considered.
• Familiarity with healthcare operations, regulatory environments, or administrative processes preferred; credentialing-specific knowledge is not required at hire.
• Strong organizational skills with attention to detail and ability to manage multiple priorities.
• Effective written and verbal communication skills.
• Ability to follow established procedures and escalate issues appropriately.

Education, Licenses and/or Certifications Required:

• High School Diploma or GED and 3-5 years of relevant experience.

Preferred Qualifications:

• Bachelor's Degree and 1-2 years relevant experience.
• Experience with CAQH, PECOS, or similar credentialing/enrollment systems.
• Experience in a federally qualified health center (FQHC) or similar setting.
• Prior supervisory experience.

Competencies Required:

Customer Service:

• Professional, courteous, and responsive in interactions with providers and internal stakeholders.
• Demonstrates commitment to accuracy and timeliness.

Cooperation/Teamwork:

• Works effectively under direction of the Credentialing Manager.
• Collaborates with HR, clinical leadership, and administrative teams.
• Seeks guidance when needed and communicates status proactively.

Minimal Training Time:

180-day introductory period.


Working Conditions:

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit, talk and hear.

The employee is occasionally required to move about the office; use hands and fingers to feel, handle, or operate office equipment.

Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work is primarily in a general primary care setting which includes the unpredictability in behaviors of individuals and acute and chronic infectious diseases which may be contagious. Adequate preparation and precaution is necessary.


Disclaimer

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. This position may be required to perform other duties. If such work becomes a permanent and regular part of the job, a new description will be prepared.


Equal Opportunity Employer

Ryan Health is an Equal Opportunity Employer and does not discriminate on the basis of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, gender identity, military veteran status, or any other characteristic protected by law.