Credentialing Coordinator

Credentialing Coordinator

Credentialing Coordinator's primary objective to coordinate and support the day-to-day credentialing activities for clinical providers, including Primary Care Providers, Specialists, and Ancillary Providers. The role requires an assertive, proactive individual who takes initiative, learns quickly, and follows instructions accurately to ensure timely and compliant credentialing outcomes.

Responsibilities

• Comply with Credentialing Policy and Procedures, Departmental Guidelines and Company Policy
• Follow established timelines for processing and completion of applications
• Process and submit Medicaid initial enrollment, revalidation, and re-credentialing applications across multiple states, including NY, TX, OH, PA, MA, NE, and NJ, in compliance with state-specific requirements.
• Navigate and maintain enrollments within state Medicaid portals and systems (e.g., NYS Medicaid, TMHP, MITS, PROMISe, MA MMIS, NJ MMIS), ensuring accuracy and completeness of provider records.
• Monitor application statuses, follow up on outstanding actions, and respond promptly to requests for additional information or corrections.
• Track state-specific revalidation cycles and deadlines to prevent lapses, denials, or terminations in Medicaid participation.
• Coordinate with internal teams such as Office Administrators and Revenue Cycle Management (RCM) to resolve Medicaid enrollment issues impacting claims and reimbursement.
• Work directly with providers and practice staff to obtain, verify, and maintain required documentation, including licenses, DEA, board certifications, practice locations, and ownership disclosures.
• Identify, troubleshoot, and escalate complex or delayed Medicaid enrollment issues, including system errors, site visits, or compliance flags.
• Maintain accurate credentialing logs, trackers, and documentation to support audits and reporting requirements.
• Ensure all Medicaid credentialing activities adhere to federal, state, and organizational compliance standards.
• Complete other tasks or projects assigned
• Provide back-up to other Credentialing staff as necessary

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Qualifications

Education Experience:

• Bachelor's Degree in a Health-Related Discipline: Public Health, Healthcare Administrative, Health Service, Psychology or Sociology Highly Preferred

• High School Diploma Required

Work Experience:

• Minimum of at least six months in a healthcare setting: providing clerical support or medical credentialing assistance

Preferred:

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) a plus

• Experience in a multi-specialty medical group or large healthcare organization

• Process improvement or workflow optimization experience

Knowledge, Skills, Abilities and Other Characteristics:

• Strong interpersonal and communication skills with an ability to work effectively with a wide range of people, teams, managers, supervisors, and vendors.

• Proficient with MS Office (outlook, word, excel, power point, access)

• Excellent organizational and time-management skills.

• Excellent verbal and written communication skills.

• Ability to analyze, interprets and draws inferences from research findings, and prepares reports.

• Working knowledge of clinical operations and procedures.

• Informational research skills.

• Ability to use independent judgment to manage and impart confidential information.

• Database management skills including querying, reporting, and document generation.

• Ability to make administrative/procedural decisions and judgments

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.

Work Environment : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Position Type and Expected Hours to Work: Full-Time Position

Monday through Friday from 9:00 a.m. to 5:30 p.m. 40 hours work week

Travel: No travel is expected or required for this position.

Supervisor Responsibility: As described above.

Equal Opportunity Employer

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.