Credentialing Coordinator

Community Care of West Virginia; Buckhannon (WV); Remote; USD 45,000 - 60,000; Full time

Job summary

A leading healthcare organization in West Virginia is seeking a Credentialing Coordinator to manage the credentialing process for its providers. This role involves ensuring compliance with regulatory standards and maintaining accurate provider data. The position requires excellent organizational skills and the ability to communicate effectively with healthcare professionals. After a training period, the role will be remote, offering flexibility while supporting the mission of Community Care of West Virginia.

Qualifications

• Responsible for leading and maintaining the credentialing process.
• Ensures compliance with regulatory agencies.

Responsibilities

• Conducts timely follow-up with providers regarding applications.
• Prepares credentialing files for review by the Board.
• Maintains current licenses and certifications for all providers.

Skills

Teamwork

Problem Solving

Productivity/Efficiency

Education

Relevant Licensure

Job description

Join to apply for the Credentialing Coordinator role at Community Care of West Virginia.

1 week ago Be among the first 25 applicants

Join to apply for the Credentialing Coordinator role at Community Care of West Virginia.

• TRAINING PERIOD UP TO 6 MONTHS BASED ON EXPERIENCE IN FLATWOODS AND BUCKHANNON OFFICES

WILL BE REMOTE AFTER TRAINING COMPLETE

Job Objective

The Credentialing Coordinator is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process for all providers who provide care at Community Care of West Virginia (CCWV) facilities. Facilitates all aspects of CCWV credentialing, including ensuring providers are credentialed, appointed, and privileged with health plans, hospitals (as needed), and patient care facilities. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing applications and related documents. Maintains up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Position Responsibilities/ Essential Duties

• Makes contact with new providers, explains the CCWV credentialing process, and remains available for additional assistance.
• Conducts timely follow-up with providers regarding application, missing documents, or incomplete information.
• Leads, coordinates, and monitors the review and analysis of practitioner applications and documents, ensuring applicant eligibility.
• Conducts research and primary source verification of all application components.
• Identifies issues requiring further investigation, validates discrepancies, and ensures appropriate follow-up.
• Prepares credentialing files for review by the CCWV Board of Directors, ensuring completeness within specified timeframes.
• Responds to inquiries from healthcare organizations and interfaces with internal and external customers on credentialing issues.
• Conducts internal credentialing file audits regularly.
• Submits and retrieves reports such as National Practitioner Database reports per regulations.
• Maintains current licenses, certifications, and credentialing documents for all providers.
• Monitors the credentialing process for medical staff compliance with regulatory bodies and policies.
• Maintains knowledge of health plan and agency credentialing requirements.
• Provides updates to senior management on application statuses.
• Prepares and updates provider agreements as needed.
• Supports the Mission, Values, and Vision of CCWV.
• Performs other duties as assigned.

Additional Sections

Include sections on Teamwork, Problem Solving, Productivity/Efficiency, Adherence to Policies, Benefits, Education & Qualifications, Licensure, Experience, Skills, Physical Demands, and Work Conditions, as in the original description, formatted with appropriate HTML tags for clarity.