Credentialing Coordinator

Job Summary and Responsibilities As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements. Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re-credentialing process. To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow. Essential Functions Coordinate and process initial credentialing, recredentialing. Maintains up-to-date physician database of all applications, demographics, medical licenses, drug enforcement, professional liability insurance, training, board certification etc. Review credentialing applications for completeness, accuracy, and compliance with regulatory and accreditation standards. Perform primary source verification of provider licenses, certifications, education, training, work history, malpractice coverage, and sanctions. Maintain and update provider credentialing files, databases, and tracking systems. Job Requirements Required High School Diploma / GED Three (3) years experience in a Health Care Plan Credentialing/Provider Relations and/or auditing setting, or Health Care Enrollment Preferred Bachelor's degree Certified Provider Credentialing Specialist (CPCS) Five (5) years of experience #J-18808-Ljbffr St Joseph Hospital & Medical Center