Credentialing Coordinator

WellPower - All Jobs; Denver (CO); Hybrid; USD 58,000 - 81,000; Full time

Job summary

WellPower is seeking a Credentialing Coordinator to manage credentialing and re-credentialing for healthcare providers, interns, residents and volunteers, ensuring compliance with NCQA, CMS, HRSA and state regulations.

This is a full-time, hybrid position in the Greater Denver Metro area. The role entails processing documentation, maintaining files, and partnering with payers and internal teams to support credentialing activities.

Qualifications

• High School Diploma or GED required.
• 2+ years of medical credentialing or provider enrollment experience.
• Associate’s degree in healthcare administration, business, or related field preferred.

Responsibilities

• Collect, verify, and process provider documentation (licenses, certifications, education, work history, malpractice).
• Submit applications to insurance payers and monitor approval status.
• Maintain credentialing files in compliance with NCQA, HRSA, CMS, and state regulations.
• Track expiration dates and notify providers of renewals.
• Maintain CAQH and NPI profiles.
• Serve as liaison between providers, insurance companies, and internal departments.
• Generate reports for leadership and assist with audits.

Skills

Credentialing

Education

High School Diploma or GED

Associate’s degree in healthcare administration

Job description

Position Summary:

The Credentialing Coordinator is responsible for managing and maintaining the credentialing and re-credentialing process for healthcare providers, interns/students/residents and volunteers to ensurecompliance with regulatory standards, accreditation requirements, and organizational policies. This roleensures that all WellPower Medical Staff meet the qualifications and maintain active status withinsurance networks and governing bodies while also developing and maintaining a working knowledgeof relevant statutes and laws.

Compensation & Benefits:

• $57,803.20 -$80,995.20 per year
• For complete overview of our robust Benefits:

The posted range represents the full hiring range. Offers will not exceed this range, the majority of candidates are placed near the midpoint based on experience and qualifications.

Job Duties & Functions:

• Collect, verify, and process provider documentation including but not limited to licenses,certifications, education, work history, and malpractice history.
• Submit applications to insurance payers and monitor approval status.
• Maintain accurate and up-to-date credentialing files in compliance with NCQA, HRSA, CMS,and state regulations.
• Ensure adherence to organizational policies, federal and state regulations, and accreditationstandards.
• Track expiration dates for licenses, certifications, and other credentials; notify providers ofupcoming renewals.
• Verify all renewal information and update the provider credentialing file
• Maintain credentialing database and provider records with high accuracy.
• Generate reports for leadership and assist with audits as needed.
• Maintain CAQH and NPI profiles for providers
• Serve as a liaison between providers, insurance companies, and internal departments.
• Perform other duties as assigned
• Maintain a trauma informed environment of wellbeing.
• Other duties as assigned

Requirements & Qualifications:

• High School Diploma or GED.
• 2+ years of medical credentialing and /or provider enrollment experience
• Associate’s degree in healthcare administration, business, or relevant work preferred

Work Location:

This is a hybrid opportunity open to folks residing in the Greater Denver Metro area.

Shift/Hours:

For example: This is a Monday-Friday opportunity observing standard business hours.

Physical Requirements:

Requires sitting, standing, bending and reaching. May require lifting up to 20 pounds. Requires manualdexterity sufficient to operate standard office machines such as computers, fax machines, the telephoneand other office and/or clinical equipment.

Working Conditions:

This is a full-time, hybrid position with a standard schedule of Monday through Friday during regular business hours. The role includes a combination of remote work and on-site presence at the organization’s main office, as needed to support credentialing activities, meetings, and events.

Applications will be reviewed on an ongoing basis.

Learn more about WellPower:

WellPower is committed to fair and equitable hiring with salaries based on relevant factors, such as work experience, education, and certification/licensure (rather than wage history). Toward the principle of equal pay for equal work, we post and hire within defined hiring salary ranges. We ask all applicants to carefully review the hiring salary range for each posted job opportunity, as we will not hire outside the predetermined range.

WellPower is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment, transfer, or promotion opportunities without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

For a complete overview of our robust benefits, visit:

https://wellpower.org/workplace-of-choice