Credentialing Coordinator / Analyst

Overview

As a Credentialing Coordinator / Analyst, you’ll keep provider credentialing and payer enrollment processes accurate, organized, and moving forward. You’ll review applications, maintain records, and apply healthcare regulations and compliance standards to support timely, reliable decisions. Your impact: Accurate credentialing and enrollment records help providers participate in health plans and help patients access care.

Responsibilities

• Review medical credentialing applications and supporting documents for completeness, accuracy, and compliance.
• Coordinate medical payer enrollment and credentialing workflows, tracking status and following up on missing information.
• Maintain credentialing databases and use medical credentialing software and other healthcare software applications to update provider records.
• Apply Centers for Medicare and Medicaid Services (CMS) requirements, CMS regulatory compliance, state healthcare regulations, managed care requirements, National Committee for Quality Assurance (NCQA) standards, JCAHO (The Joint Commission) requirements, and other accreditation standards.
• Handle confidential information carefully; support contract management and maintain clear documentation.

Qualifications

• Administrative experience within healthcare; medical office experience is helpful.
• Knowledge of medical credentialing, health insurance, managed care, medical terminology, health regulation policy, and healthcare compliance.
• Experience with medical credentialing application review, database management, and healthcare software applications.
• Proficiency with Microsoft Office and familiarity with medical credentialing software.
• Contract management experience in healthcare and knowledge of NCQA, JCAHO, CMS, state regulations, and accreditation standards are preferred.

Pay: $24.51 - $29.51 per hour

Expected hours: 25.0 – 40.0 per week

Work Location: In person