Credentialing Coordinator Job Description

Credentialing Coordinator Job Description Template

We are looking to hire an organized credentialing coordinator to assist us with administrative tasks pertaining to our practitioners' credentialing. The credentialing coordinator will organize, maintain, and verify all aspects of the process, and maintain current files on practitioners. You will track the expiration of certifications to maintain up-to-date files, and assist health plan providers and customers with phone inquiries.

To be successful in this role you should ensure the currency and accuracy of all information. Preferred candidates will be reliable, energetic, and have excellent people skills.

Credentialing Coordinator Responsibilities:

• Processing initial credentialing and re-credentialing applications.
• Screening practitioners' applications and supporting documentation to ascertain their eligibility.
• Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other relevant sources.
• Identifying discrepancies in information and conducting follow-ups.
• Presenting applications to the facility’s Credentialing Committee.
• Assisting customers with credentialing inquiries.
• Responding to health plan provider inquiries.
• Capturing primary source documentation in computer databases.
• Ensuring data is backed up.
• Ensuring compliance with applicable laws, regulations, procedures, and policies.

Credentialing Coordinator Requirements:

• High school diploma, GED, or suitable equivalent.
• 2+ years of credentialing experience with hospital medical staff.
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
• Knowledge of medical credentialing and privileging procedures and standards.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Word and Excel.
• Proficient touch-typing skills.
• Ability to focus for extended periods.