Credentialing Coordinator

VIVA USA Inc; Farmers Branch (TX); On-site; USD 48,000 - 62,000; Full time

Job summary

VIVA USA Inc. seeks a Credentialing Coordinator in Farmers Branch, TX to ensure compliance with NCQA, URAC, Medicare/Medicaid, and client requirements. You will verify credentials, enroll clinicians, and manage licensure across state and federal guidelines.

The role emphasizes data accuracy, cross-department collaboration, and timely processing within a credentialing hub. Strong attention to detail and healthcare regulatory knowledge are essential.

Qualifications

• NAMSS CPCS Certification preferred.
• CAQH experience preferred.
• MD staff experience preferred.
• Google Suites experience preferred.
• Licensure experience highly preferred.

Responsibilities

• Verify state licenses, exclusions lists, DEAs, board certifications and Medicaid/Medicare enrollment verifications to ensure clinicians remain active in the network.
• Enroll clinicians in Medicare and Medicaid following state and federal guidelines.
• Apply for state licensure for clinicians.
• Enter, update and maintain data from provider applications into the credentialing database with accuracy.
• Prepare, issue, track and follow up on verifications for efficient processing of applications.
• Communicate with providers and internal/external clients to provide timely responses.
• Maintain ongoing professional development to stay current with regulations in healthcare credentialing.

Skills

Attention to detail

Administrative skills

Licensure verification

Tools

Google Suites

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

The candidate 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; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides 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 client 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.

QUALIFICATIONS:

Preferred NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) . Preferred CAQH Experience, preferred MD Staff Experience, preferred Goggle Suites Experience and highly preferred Licensure Experience.

Experience & Skills:

Preferred Experience: 1–3 years

Credentialing or licensure experience highly preferred

Top 3 Non-Negotiables:

• Ability to verify licensure and education
• Experience filling out applications
• Strong attention to detail and admin skills

Experience Level:

Level I (0-3 Years)

Notes:

Work Schedule:

• Flexible shifts between 7:00 AM – 5:00 PM CST
• Options for 30-minute or 1-hour lunch breaks
• Must work CST hours regardless of time zone

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status