Credentialing Coordinator

We are seeking a detail-oriented Credentialing Analyst / Coordinator to oversee data analysis and the initial credentialing and re-credentialing process for Nurse Practitioners, Physician Assistants, Behavioral Health Providers, and Physicians. In this role, you will ensure full compliance with internal standards, Joint Commission accreditation, NCQA, and URAC credentialing standards while monitoring expired credentials and licensure status.

Position Type: Contract (6 Months to start, potential for extension or permanent opportunities)

Pay Rate: $25.00 / hour

Location: Hybrid (Onsite location: Cumberland, RI)

Work Schedule: Monday – Friday, 8:00 AM – 4:30 PM ET

Training hours are the same as regular working hours (Monday – Friday, 8:00 AM – 4:30 PM ET).

Key Responsibilities

• Credentialing & Re-Credentialing: Process initial and re-credentialing applications for providers (NP, PA, MD) accurately and in compliance with established credentialing programs.
• Compliance & Licensure Monitoring: Monitor expired licensure reporting, database tasks, and weekly updates for leadership. Conduct sanctions and compliance monitoring, alerting management to any undisclosed negative findings.
• Access & System Management: Manage Epic access for providers with out-of-compliance licensure or board certifications. Submit system access requests upon credentialing approval or clinic eligibility.
• Database & Grid Maintenance: Maintain provider files, update daily credentialing grids, and handle database updates for provider/clinic change or termination reports and name changes.
• Stakeholder Collaboration: Maintain provider and physician SharePoint sites, support the payer enrollment team on claim issues, and communicate status updates across leadership and internal teams.
• Audits & Administrative Support: Support payer audits in accordance with Joint Commission, NCQA, and internal requirements. Handle incoming mail distribution, malpractice insurance verification requests, and process improvement recommendations.

Requirements & Qualifications

• Experience: Minimum of 3 years of experience in the healthcare industry focused on credentialing and re-credentialing practices.
• Technical Skills: Competent user of Microsoft Office (Excel, Word, Outlook) and MDStaff . Experience with quantitative analysis required.
• Regulatory Standards: Demonstrated understanding of Joint Commission Accreditation, NCQA, and URAC credentialing standards.
• Core Competencies: Strong organizational skills, ability to multitask, excellent written and verbal communication, and strong interpersonal skills for internal and external collaboration.
• Work Style: Ability to function independently and utilize critical thinking skills to accomplish goals and objectives.

Preferred Qualifications

• NAMSS Certified Professional Credentialing Specialist (CPCS) certification.