Job Description:
Position Summary:

The Credentialing Coordinator role will be responsible on ensuring compliance with NCQA, URAC, Medicare, Medicaid, Delegation agreements and other pertinent client requirements, policies and procedures, client health plan contracts, URAC guidelines and applicable state and federal requirements.

Responsibilities may include:
• Verifying State Licenses, exclusions lists, DEA’s, Board Certifications and Medicaid/Medicare Enrollment Verifications on an ongoing basis to ensure qualified and approved clinicians remain active in the network.
• Enrolling clinicians in Medicare and Medicaid following state and federal guidelines.
• Applying for state licensure for clinicians.

S/He will maintain strong cross-departmental relationships with Recruiting, Production, and Education. This role will report to our Supervisor of the Credentialing Hub.

Candidates will monitor files to ensure completeness and accuracy; review all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepare and provide information to internal and external customers as appropriate. Enters, updates, and maintains data from provider applications into the credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses and in accordance with internal policies and procedures. Prepares, issues, electronically tracks, and follows up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.

Communicates clearly with providers, internal/external clients, and all Signify Health staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest developments to enhance understanding of various regulations and legislation of the healthcare industry and assist with special projects on an as-needed basis.

Key Responsibilities:

• Ensure compliance with NCQA, URAC, Medicare, Medicaid, and other client requirements.
• Verify licensure, certifications, DEA, exclusions lists, and enrollment status.
• Manage enrollment of clinicians into Medicare and Medicaid.
• Apply for state licensure for clinicians.
• Maintain credentialing database with accurate and complete provider data.
• Review and monitor provider files for compliance with accreditation and quality standards.
• Prepare and distribute information to internal and external stakeholders.
• Communicate clearly with providers, staff, and clients to resolve credentialing issues.
• Process high-volume credentialing applications within established timelines.
• Stay current with healthcare regulations, credentialing standards, and compliance requirements.

Knowledge, Skills, and Abilities:

• Ability to verify licensure and education.
• Experience filling out applications and maintaining compliance documentation.
• Strong attention to detail, organizational skills, and administrative ability.
• Effective communication skills with internal and external stakeholders.
• High degree of accuracy when managing sensitive data (PHI).

Qualifications:

• Preferred NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS).
• Preferred CAQH experience.
• Preferred MD Staff experience.
• Preferred Google Suites experience.
• Highly preferred licensure experience.
• 1–3 years of relevant credentialing or licensure experience (preferred).

Compliance & Hiring Process:

• Candidate will have access to PHI (Personal Health Information).
• Drug test required due to data sensitivity.
• Interview Platform: Google Meet.