Credentialing Coordinator

Jobtailor; Town of Florida (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor in the United States (New York) seeks an experienced Credentialing Compliance Lead to manage program-level compliance activities, audits, and delegated oversight. You will coordinate credentialing and re-credentialing processes, oversee contracted organizations, and liaise with vendors to ensure regulatory adherence.

The role emphasizes contract monitoring, issue resolution, and continuous process improvements, with daily operational oversight and collaboration with internal partners

Qualifications

• Requires a BA/BS degree in a related field and minimum 5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.

Responsibilities

• Coordinate and lead credentialing program-level compliance activities for sanction monitoring, delegation oversight audits, and regulatory and compliance audits.
• Oversee credentialing and re-credentialing activities and processes, including internal and external audits.
• Manage accounts for contracted organizations.
• Liaise with delegates and credentialing vendors to maintain credentialing program compliance.
• Monitor contract compliance and coordinate or negotiate contractual language changes.
• Coordinate compliance filings for credentialing-specific documents and policies.
• Coordinate and conduct initial, annual, focused, vendor, delegation oversight, and department audits.
• Provide feedback and recommendations to improve processes and performance.
• Resolve issues involving delegation oversight, sanction monitoring, validation, notification, system configuration and reporting, and credentialing policy and procedural reviews and exceptions.
• Serve as corporate contact and interface with internal business partners regarding problems, resolutions, questions, and regulatory or accreditation audits.
• Oversee daily business operations related to resolving non-responsive providers.
• Maintain delegation/credentialing standards and business requirements.
• Research and resolve delegated credentialing-related issues.
• Provide recommendations to committees on process administration.
• Review assigned Health Plan elements in the Credentialing Manual and update documentation resources and business rules.
• Lead special projects.

Skills

Credentialing Program Compliance

Auditing Oversight

Delegation Oversight

Credentialing Certification

Contract Management

Education

BA/BS degree in a related field

Tools

Documentation Management

Job description

• Coordinate and lead credentialing program-level compliance activities for sanction monitoring, delegation oversight audits, and regulatory and compliance audits.


• Oversee credentialing and re-credentialing activities and processes, including internal and external audits.


• Manage accounts for contracted organizations.


• Liaise with delegates and credentialing vendors to maintain credentialing program compliance.


• Monitor contract compliance and coordinate or negotiate contractual language changes.


• Coordinate compliance filings for credentialing-specific documents and policies.


• Coordinate and conduct initial, annual, focused, vendor, delegation oversight, and department audits.


• Provide feedback and recommendations to improve processes and performance.


• Resolve issues involving delegation oversight, sanction monitoring, validation, notification, system configuration and reporting, and credentialing policy and procedural reviews and exceptions.


• Serve as corporate contact and interface with internal business partners regarding problems, resolutions, questions, and regulatory or accreditation audits.


• Oversee daily business operations related to resolving non-responsive providers.


• Maintain delegation/credentialing standards and business requirements.


• Research and resolve delegated credentialing-related issues.


• Provide recommendations to committees on process administration.


• Review assigned Health Plan elements in the Credentialing Manual and update documentation resources and business rules.


• Lead special projects.

Requirements

• Requires a BA/BS degree in a related field and minimum 5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.


• Strongly preferred credentialing certification.


• Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law.


• New candidates in certain patient/member-facing roles are required to become vaccinated against COVID-19 and Influenza; exceptions require an acceptable explanation.


• Must support credentialing program compliance, audits, sanctions monitoring, delegation oversight, and regulatory requirements.

Core Competencies

Demonstrates expertise in credentialing program compliance, including oversight of audits, sanction monitoring, and regulatory requirements. Proven ability to manage relationships with vendors and delegates while improving processes and performance.

Highest-signal resume keywords

• Credentialing Program Compliance


• Auditing and Compliance Oversight


• Delegation Oversight


• Credentialing Certification


• Contract Management

ATS Optimization Keywords

Hard Skills

• Credentialing Experience


• Regulatory Compliance


• Audit Coordination


• Sanction Monitoring


• Process Improvement


• Documentation Management


• Issue Resolution


• Contract Negotiation


• Delegated Credentialing


• Health Plan Documentation

Soft Skills

• Communication


• Problem-Solving


• Collaboration


• Leadership


• Feedback Provision

Certifications & Qualifications

• Credentialing Certification

Industry Keywords

• Credentialing


• Compliance Audits


• Delegation Oversight


• Regulatory Requirements


• Contract Compliance