Credentialing Coordinator lll

El Camino Health Medical Network; Los Gatos (CA); On-site; USD 107,710,000 - 130,920,000; Full time

Job summary

El Camino Health Medical Network is seeking a Credentialing Coordinator III to oversee end-to-end credentialing and re-credentialing for providers across the network. You will partner with the internal CVO to audit files, track timelines, and ensure verification standards meet regulatory and organizational policies.

In this role, you will manage provider communications, maintain CAQH profiles, prepare credentialing materials for committee review, and support audits and enrollment tasks while

Qualifications

• Familiarity with CAQH, credentialing software, and accreditation standards.
• CPCS certification preferred, or willingness to obtain CPCS.
• Experience in credentialing or provider data management in healthcare.

Responsibilities

• Oversee credentialing and re-credentialing applications for network providers.
• Audit credentialing data and ensure accuracy and compliance.
• Prepare and format credentialing materials for committee reviews.
• Support enrollment tasks and NCQA/compliance audits.

Skills

Attention to detail

Time management

Prioritization

Communication skills

Education

High School diploma or GED

Associate’s or Bachelor’s degree preferred

Tools

CAQH

Credentialing software

Microsoft Office

Job description

El Camino Health Medical Network is currently seeking a talented Credentialing Coordinator III to join our growing healthcare team!

• Pay: $37.59-$45.69/ hour
• Location: Los Gatos, CA
• Shift: Days, Mon-Friday 9:00am-5:00pm

El Camino Health Medical Network (ECHMN) is a growing healthcare provider organization delivering high-quality, community-based ambulatory care across the Greater Silicon Valley. We are committed to coordinating care that meets the needs of the diverse communities we serve, while simplifying the healthcare experience for both patients and providers.

At ECHMN, we value collaboration, accountability, and innovation. Our teams work closely across disciplines to support physicians, improve access to care, and deliver a consistently high standard of service. We offer a supportive and engaging work environment where individuals are empowered to make an impact and contribute to meaningful growth.

If you are passionate about healthcare, driven by purpose, and eager to work in a collaborative, patient-centered organization, we invite you to explore a career with El Camino Health Medical Network.

Summary

The Credentialing Coordinator III is responsible for overseeing the end-to-end credentialing and re-credentialing process for providers within the El Camino Health Medical Network (ECHMN). This role partners strategically with the internal CVO to audit provider files, track credentialing timelines, and ensure all credentials and verifications are up-to-date and compliant with organizational policies and regulatory standards.

Credentialing Process Management

• Coordinate with the internal CVO to oversee, track credentialing and re-credentialing applications for all network providers.
• Audit the credentialing database regularly to ensure data integrity, compliance, and maintain accurate up-to-date records.
• Oversee the final quality control review of the credentialing files, ensuring the files meet standards requirements and organization policies before final approval.
• Upload provider credentialing renewals and supporting documentation into the database.
• Partner with the CVO to identify, troubleshoot, and resolve complex credentialing barriers and streamline the provider onboarding.

Provider Communication & Coordination

• Serve as the senior point of contact for providers, delivering guidance and reminders for outstanding documentation or upcoming expirations.
• Follow up with providers to collect required documentation; respond to credentialing-related emails and requests.
• Assist the network providers in completing and updating CAQH profiles and ensure profile accuracy.

Committee & Reporting Support

• Facilitate and attend credentialing committee preparation, including summaries, taking minutes and tracking post-committee action items.
• Assist the manager with provider enrollment tasks as assigned, including the preparation and initial formatting of provider rosters and credentialing reports.
• Support the manager during health plans delegation audits by pulling requested files, verifying NCQA compliance, and organizing audit evidence.
• Ensure all committee materials are prepared and submitted in a timely manner.

Administrative Support & Compliance

• Maintain strict provider confidentiality and handle sensitive information with professionalism.
• Ensure all credentialing activities comply with HR, HIPAA, safety, and internal compliance policies.
• Mentor or provide peer guidance to junior credentialing staff on complex files and standard operating procedures.
• Support additional administrative tasks and cross-functional responsibilities within the credentialing and provider services team.
• Serve as the primary backup to the Credentialing and Provider Enrollment Supervisor.

Minimum Requirements

Education

• High School diploma or GED; Associate’s or Bachelor’s degree preferred.
• Minimum of 3-5 years of experience in credentialing or provider data management within a healthcare setting.

Experience

• Familiarity with CAQH, credentialing software, and applicable accreditation standards (e.g., NCQA, CMS, Joint Commission).
• Certification as a Certified Provider Credentialing Specialist (CPCS) is highly preferred, or a strong willingness to obtain CPCS certification.

Other Knowledge, Skills, And Abilities

• Strong understanding of credentialing processes and regulatory compliance standards.
• Excellent attention to detail, strong organizational and time management,
• Ability to prioritize tasks, manage multiple files simultaneously, and meet strict operational deadlines.
• Proficient in Microsoft Office (Outlook, Word, Excel, Teams), credentialing databases and CAQH platforms
• Professional verbal and written communication skills; ability to work effectively with providers and internal departments.
• Ability to maintain confidentiality and professionalism in all interactions.