credentialing coordinator

CommonSpirit Health

<div>Job Summary and Responsibilities<div> 
As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements. 
 
Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re-credentialing process. 
 
To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow.</div><ul><li>
Completes all new clinic providers credentialing and /or provides oversight with the privileging process to ensure all necessary documentation is available to grant billing, hospital, and practice privileges. This includes working with providers to obtain information and time-sensitive renewal documentation with the expedient completion of the following, but not limited to:</li><li>
Maintains an accurate, current, centralized credential file for all providers in CHI Health.</li><li>
Processes all recredentialing requests for CHI Health providers based on regulatory time and content requirements.</li><li>
Obtains verification of licensure, malpractice insurance/information/history, etc., required certificates (e.g. medical school diploma, residency training, board certification, etc.) directly from the provider or through communication with the appropriate clinic liaison in a timely fashion prior to initial privileging review by the Medical Executive Officer and CQC.</li><li>
Alerts appropriate clinic management staff of potential risks or conflict issues that may arise from any of the privileging, credentialing, and deprivileging processes.</li><li>
Notifies the appropriate personnel of revisions in the demographic information of CHI Health providers to maintain the most current data base that may require access by hospital personnel, insurance companies, PHO, etc.</li></ul> 

Job Requirements<div> 
Preferred</div><ul><li>
High School GED General Studies, upon hire or</li><li>
High School Graduate General Studies, upon hire</li></ul>
Where You'll Work<div> 
From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.</div> 
Pay Range 
$24.27 - $36.10 /hour</div>

Credentialing Coordinator

CHRISTUS Health

<div>Description 
Summary:
Assures the proper credentialing of physicians, professionals, and paraprofessional individuals with staff privileges. Provides administrative and secretarial support to the medical staff. Records, transcribes, and maintains all necessary records.
Responsibilities:
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
The Credentials Verifications Office (CVO) Medical Staff Coordinator is responsible for the coordination of medical Staff credentialing and privileging.</li><li>
The CVO Medical Staff Coordinator prioritizes the work processes and monitors the performance of the Credentialing Specialist</li><li>
Process and expedite the CVO credentialing of Medical Staff and Allied Health Professional applications, appointments, reappointments, requests for change in privileges, and changes in status.</li><li>
Maintain credentials files, reflecting current licensure, liability insurance, board certification, etc.</li><li>
Maintain current data in credentialing software system for easy and accurate access upon request.</li><li>
Prepare reports from credentialing software as requested.</li><li>
Act as liaison to all members of the Medical Staff by handling telephone and written requests for verification information.</li><li>
Other duties as assigned.</li></ul>
Requirements:
Education/Skills
<ul><li>High School Diploma or equivalent</li></ul>
Experience 
<ul><li>1-3 years&rsquo; experience preferred</li></ul>
Licenses, Registrations, or Certifications 
<ul><li>Certified Provider Credentialing Specialist (CPCS) certification within 2 years of hire.</li></ul>
Work Schedule: 
8AM - 5PM Monday-Friday
Work Type:
Full Time</div>

Coordinator Medical Staff - Med Staff Administration - Full Time

Molina Healthcare

Job Summary
 
Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.
 
Job Duties
 
Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.
 
Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.
 
Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.
 
JOB QUALIFICATIONS
 
Required Education: High School Diploma or GED.
 
Required Experience/Knowledge Skills & Abilities
 
<ul>
<li>Experience in a production or administrative role requiring self-direction and critical thinking.</li>
<li>Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.</li>
<li>Experience with professional written and verbal communication.</li>
</ul>
Preferred Experience: 
<ul>
<li>Experience in the health care industry</li>
<li>Experiece with Provider credentialling</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $22.36 - $34.88 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Assoc Specialist, National Credentialing (Provider Credentialing) Remote

Revmed

Job Summary:We are seeking a detail-oriented and experienced Medical Credentialing &amp; Enrollment Specialist to manage provider credentialing, re-credentialing, and payer enrollment processes. The ideal candidate will ensure compliance with insurance and regulatory requirements while maintaining accurate provider records and timely submissions.Key Responsibilities:<ul><li>Manage end-to-end provider credentialing and enrollment with insurance payers (Medicare, Medicaid, Commercial Plans).</li><li>Prepare and submit initial credentialing and re-credentialing applications.</li><li>Maintain and update provider information in CAQH (Council for Affordable Quality Healthcare).</li><li>Track application status and follow up with payers to ensure timely approvals.</li><li>Handle provider enrollment, revalidation, and demographic updates.</li><li>Maintain accurate records of provider credentials, licenses, certifications, and expirations.</li><li>Coordinate with internal departments (billing, HR, compliance) for required documentation.</li><li>Resolve credentialing-related issues and payer denials.</li><li>Ensure compliance with healthcare regulations and payer requirements.</li><li>Maintain credentialing database and prepare reports as required.</li></ul>Requirements:<ul><li>Bachelor&rsquo;s degree or relevant experience in Healthcare Administration or related field.</li><li>1&ndash;3+ years of experience in US medical credentialing and enrollment.</li><li>Hands-on experience with CAQH, PECOS, NPPES, and payer portals.</li><li>Strong knowledge of Medicare, Medicaid, and commercial insurance processes.</li><li>Excellent communication and follow-up skills.</li><li>Strong attention to detail and organizational skills.</li><li>Ability to handle multiple providers and deadlines simultaneously.</li></ul>Preferred Skills:<ul><li>Experience in RCM (Revenue Cycle Management) environment.</li><li>Familiarity with credentialing software/tools.</li><li>Knowledge of compliance and healthcare regulations.</li><li>Ability to work independently and in a team environment.</li></ul>Benefits (Customize as per your company):<ul><li>Competitive Salary Package</li><li>Post-Probation &amp; Annual Increments</li><li>Family Health Insurance</li><li>Paid Leaves &amp; Leave Encashment</li><li>Performance &amp; Retention Bonuses</li><li>Meal Allowance</li><li>Pick &amp; Drop (for female staff)</li></ul>Job Type: Full-timeWork Location: In person

Medical Credentialing & Enrollment Specialists

Meds IT Nexus

Job descriptionMeds Nexus is looking for candidates on the night shift with experience as Team Lead Credentialing &amp; EDI. The candidate should be enthusiastic and must have a proven work experience in performing all New Client Account Setups, Research and Development activities, ensuring that the credentialing requirements for government and commercial payers are met, Submit and follow-up on submitted credentialing requests to all contracted commercial payers and government agencies, maintain the close working relations experience will be preferred along with Basic IT skills (databases, MS Office, etc.)Job Responsibilities:3 to 5 years of experience in credentialing departmentAt least 1 year of experience in a Supervisory RoleExperience in credentialing different specialties with major regular and private payers state-wiseReview the approval and termination of professional provider contracts as they relate to the credentialing processEnsure accurate and timely information for re-credentialing, data analysis, and directory generation, as well as recommending changes to the credentialing criteria and processesMaintain all credentialing and re-credentialing policies and processes to ensure that they comply with all applicable regulationsDevelop and implement departmental goals and objectives with input from staff membersDevelop and implement departmental policies and procedures that guide and support the provision of servicesInteract with all customers to ensure prompt and accurate communication as needed to provide the service expected and to meet the goals of the service.Job Types: Contract, Full-timeAbility to commute/relocate:<ul><li>Rawalpindi: Reliably commute or planning to relocate before starting work (Required)</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Credentialing &amp; Enrollment + EDI: 5+ years (Preferred)</li></ul>Language:<ul><li>Fluent English (Preferred)</li></ul>Job Type: Full-timeWork Location: In person

Credentialing Team Lead

The Garden of Eve

Job Title:Credentialing SpecialistWho We Are7 KINGS CODE is US based Software solutions company. We support our partners and clients globally in USA, CANADA, EUROPE, INDIA, PAKISTAN &amp; MIDDLE EAST.Education &amp; Experience Required:<ul><li>Bachelor&rsquo;s degree in healthcare administration, business, or a related field preferred. Equivalent experience may be considered.</li><li>4+ years of experience in credentialing, enrolment, or related roles in the medical billing industry.</li></ul>Skills Required:<ul><li>Solid experience in credentialing of Clinics and Labs</li><li>Familiarity with Medicare, Medicaid, and commercial payer enrolment processes.</li><li>Proficiency in credentialing software and tools (e.g., CAQH ProView, PECOS).</li><li>Strong knowledge of medical billing processes and insurance verification.</li><li>Familiarity with HIPAA and other healthcare regulations.</li></ul>Job Location: Onsite, DHA Phase 8 - Ex Park View, Lahore.Job Timings: PAK TIME: 5:30PM to 02:30AMApply with your latest cv at: hr@7kingscode.comJob Type: Full-timeAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul>Education:<ul><li>Bachelor's (Required)</li></ul>Experience:<ul><li>Credentialing of Clinics and Labs: 4 years (Required)</li></ul>Work Location: In personJob Type: Full-timePay: Rs100,000.00 - Rs150,000.00 per monthWork Location: In person

Credentialing & Enrollment specialist

EdSavvy Solutions

Job Title: Credentialing SpecialistCompany: Edsavvy Solutions Location: Lahore (Near UCP) Shift Timing: 5:00 PM &ndash; 2:00 AM Job Type: Full-timeAbout Us: Edsavvy Solutions is a Lahore-based medical billing company providing services to clients in the United States. We are seeking a detail-oriented and motivated Credentialing Specialist to join our growing team.Job Responsibilities:<ul><li>Manage provider credentialing and re-credentialing processes</li><li>Prepare and submit credentialing applications to insurance panels</li><li>Maintain accurate provider records and documentation</li><li>Follow up with insurance companies regarding application status</li><li>Ensure compliance with industry standards and client requirements</li></ul>Key Requirements:<ul><li>6 months to 2 years of experience in credentialing</li><li>Experience in dental credentialing can be considered</li><li>Strong attention to detail and organizational skills</li><li>Willingness to work in the night shift (5:00 PM &ndash; 2:00 AM)</li></ul>What We Offer:<ul><li>Professional work environment</li><li>Growth and career development opportunities</li><li>Exposure to international clients</li></ul>How to Apply: Interested candidates are encouraged to send their resumes to: Email: hr@edsavvysolutions.comPay: Rs50,000.00 - Rs100,000.00 per monthWork Location: In person

Credentialing Specialist

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