Credentialing Coordinator

Washington Health Medical Group; Fremont (CA); On-site; USD 40,000 - 48,000; Full time

Benefits offered by this job

401(k)

401(k) matching

Dental insurance

Disability insurance

Employee assistance program

Flexible spending account

Health insurance

Life insurance

Paid time off

Parental leave

Vision insurance

Job summary

Washington Township Medical Foundation is seeking a Credentialing Coordinator to support the Credentialing Department under the HR and Administrative Services leadership. You will process credentialing and re-credentialing for physicians, NPs, and PAs, verify licenses, education, and certifications, and maintain CAQH and payer databases.

This is a full-time, on-site role in a professional office environment.

Qualifications

• Must have at least 6 months to a year of related credentialing experience.
• Proficiency in Microsoft Office Suite
• Must have strong organizational skills to effectively prioritize, coordinate, perform and complete multiple duties and assignments concurrently and in a timely manner.
• Must have the ability to communicate effectively and handle sensitive/confidential information.
• Knowledge of and proficiency in English composition, spelling, grammar, punctuation, and basic math principles.

Responsibilities

• Process initial credentialing and re-credentialing applications for physicians, NPs and PAs.
• Verify licenses, certifications, education, work history, and malpractice coverage through Healthguard for primary source verification.
• Maintain credentialing databases (e.g., CAQH, payer portals) and ensure timely updates.
• Track expiration dates for licenses, DEA registrations, and certifications; proactively follow up to prevent lapses.
• Maintain Rosters.
• Administrator for Payors, including, but not limited to: granting/removing employee access, password resets, etc.
• Prepare credentialing files for internal committee review and payer submission.
• Communicate with providers to collect required documentation.
• Ensure compliance with NCQH and state/federal regulations.
• Respond to inquiries from health plans, hospitals, and internal stakeholders regarding provider status.
• Maintain confidentiality of sensitive provider information.
• Back up to the Executive Assistant/Manager of Administration.
• Other duties as assigned.

Skills

Credentialing experience

Organizational skills

Communication skills

English composition

Basic math principles

Tools

Microsoft Office Suite

Job description

Summary/Objective

Reporting to the Director of Human Resources and Administrative Services provides support to the Washington Township Medical Foundation Credentialing Department.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Process initial credentialing and re-credentialing applications for physicians, NPs and Pas
• Verify licenses, certifications, education, work history, and malpractice coverage through Healthguard for primary source verification
• Maintain credentialing databases (e.g., CAQH, payer portals) and ensure timely updates
• Track expiration dates for licenses, DEA registrations, and certifications; proactively follow up to prevent lapses
• Maintain Rosters
• Administrator for Payors, including, but not limited to: granting/removing employee access, password resets, etc.
• Prepare credentialing files for internal committee review and payer submission

• Communicate with providers to collect required documentation
• Ensure compliance with NCQH and state/federal regulations

• Respond to inquiries from health plans, hospitals, and internal stakeholders regarding provider status

• Maintain confidentiality of sensitive provider information
• Back up to the Executive Assistant/Manager of Administration.
• Other duties as assigned.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

While performing the duties of this job, the employee is regularly required to talk or hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.

Qualifications and Education Requirements

• Must have at least 6 months to a year of related credentialing experience.
• Proficiency in Microsoft Office Suite
• Must have strong organizational skills to effectively prioritize, coordinate, perform and complete multiple duties and assignments concurrently and in a timely manner.
• Must have the ability to communicate effectively and handle sensitive/confidential information.
• Knowledge of and proficiency in English composition, spelling, grammar, punctuation, and basic math principles.

Competencies

• Business Acumen
• Interpersonal Relationships
• Change Agent
• Collaboration Skills
• Communication Proficiency
• Decision Making
• Initiative
• Leadership
• Problem Solving/Analysis

Job Type: Full-time

Salary: $29.00-$35.00 per hour

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Vision insurance

Schedule

• Monday to Friday

Work Location: One location