Credentialing Coordinator

• Manage an assigned book of business throughout the initial and reappointment process
• Prepare provider credentialing files for required ACOs
• Create credentialing files and enter pertinent information from providers' initial and reappointment applications
• Upload supporting documents to the company database document vault
• Coordinate file reviews for accuracy and prepare discrepancies for quality review and approval
• Research and obtain verification of clinicians' medical experience, professional references, state licensure, DEA registration, DPS credentials, and other required documentation
• Coordinate with facilities, centralized verification services, medical staff, and clinicians to complete the privileging process
• Facilitate state-required collaborative agreements and APP supervision processes
• Provide routine status updates for assigned books of business in the system dashboard
• Maintain the company database with current documentation, licensure, and updated demographics
• Maintain accurate site rosters of currently privileged providers
• Ensure providers maintain current licensure and certifications to remain active at hospitals
• Collaborate with multiple teams and departments across organizations
• Build relationships with clients, providers, and Medical Staff Offices
• Support and lead hospital credentialing efforts for new clients
• Adhere to company policies and procedures

Provider Credentialing Coordinator

• Manage the end-to-end provider enrollment process
• Serve as the primary power user for CAQH ProView, including profile pulls, re-attestations, and troubleshooting technical enrollment hurdles
• Investigate sanctions alerts and NPDB queries
• Document and precisely escalate adverse findings
• Partner with major provider groups to audit credentialing standards
• Maintain accurate, up-to-date provider rosters
• Own the re-credentialing calendar and prevent compliance lapses
• Work with the Account Management team to resolve bottlenecks
• Maintain audit-ready documentation for licenses, COIs, and accreditations
• Support leadership decisions by maintaining a comprehensive audit trail

• Obtain and verify all required credentialing and recredentialing documentation
• Work with staff and hospital system leadership to ensure applicants have proper credentials and training to provide patient care
• Perform duties according to Medical Staff policies, bylaws, rules, regulations, and applicable legal, state, federal, licensing board, Joint Commission, and Risk Management guidelines
• Assist the Credentials Chairman and Supervisor of Medical Staff Services with privilege documents, credentialing policies, rules, and regulations
• Coordinate appointment, reappointment, and credentialing processes for medical staff and allied health professionals
• Ensure accurate documentation and verification of education, experience, and licensure
• Ensure compliance with Joint Commission standards, Medical Staff bylaws and credentialing policies, and National Practitioner Data Bank guidelines
• Initiate background checks and verify education, experience, and licensure using online systems, correspondence, telephone inquiries, and reference questionnaires and reports
• Design and implement systems for compiling, maintaining, and retrieving complete confidential medical staff records
• Monitor environmental changes for new requirements or collaboration opportunities and communicate them appropriately
• Support Medical Executive Committee and Credentials Committee meetings, including meeting minutes, follow-up actions, and monthly credentialing updates
• Serve as a resource for internal departments on credentialing issues, clinician privileges, and health plan participation changes
• Maintain accurate provider information databases
• Coordinate activities of others without supervisory responsibility
• Work with patients, customers, healthcare professionals, staff, and Director-level personnel

• Coordinate provider credentialing and recredentialing processes in accordance with regulatory requirements and organizational standards
• Collect, review, and verify provider documentation, including licenses, certifications, education, work history, malpractice insurance, and references
• Track license, certification, and credential expiration dates and help ensure timely renewals
• Complete and submit Medicare and Medicaid enrollment applications accurately and timely
• Serve as a primary point of contact for providers regarding credentialing status, required documentation, and outstanding items
• Maintain accurate provider information within credentialing software, files, and tracking systems
• Communicate with state agencies, licensing boards, CMS, and other external organizations to obtain or verify provider information
• Support credentialing-related audits, inquiries, and requests for information
• Partner with Human Resources, Compliance, and Clinical Operations to support a smooth provider onboarding and credentialing experience
• Identify and help resolve credentialing issues in a timely and professional manner
• Prepare and maintain reports related to credentialing status, turnaround times, and other key metrics
• Maintain confidentiality of provider information in accordance with HIPAA and organizational requirements

• Coordinate and monitor the review and analysis of practitioner applications and accompanying documents
• Conduct investigation, research, and timely primary source verification of application file components
• Identify issues requiring additional investigation and evaluation, validate discrepancies, and ensure follow-up
• Review documentation and verifications before client submission
• Meet turnaround time, productivity, quality, communication, collaboration, file completion, and other KPI expectations
• Respond to inquiries from other healthcare organizations
• Interface with internal and external customers on credentialing and privileging issues
• Utilize and maintain the credentialing database
• Perform queries, reports, and document generation
• Maintain strict confidentiality of data and information
• Embody SCP Health and CS Partners core values
• Perform miscellaneous job-related duties as assigned

CVO Credentialing Coordinator

• Credential or recredential professional and facility providers applying for initial or ongoing network participation
• Ensure credentialing and recredentialing are completed in a timely and appropriate manner for presentation to the medical director and/or credentialing committee
• Ensure documentation for approved providers is current at the time of committee determination
• Conduct ongoing monitoring of providers