Credentialing & Privileging Specialist - Remote

communitycare-centralhealth; Kramer (ND); On-site; USD 52,000 - 70,000; Full time

Job summary

CommUnityCare is seeking a Credentialing Coordinator to manage credentialing and recredentialing for healthcare professionals across its health centers. Under the supervision of the Credentialing Manager, you will verify licensure and sanctions and maintain records in the credentialing database to ensure ongoing regulatory compliance.

Responsibilities include PSV, data entry, timely follow-up, and collaboration with providers, health plans, and leadership to resolve issues and submit required

Qualifications

• High School Diploma required.
• 2 years of practitioner credentialing experience or related field preferred.
• Familiarity with CMS, TJC, NCQA accreditation standards preferred.

Responsibilities

• Reviews initial credentialing/recredentialing and privilege requests for completeness and compliance.
• Performs PSV (primary source verification) and validates information.
• Data entry of new applications into credentialing database.
• Communicates with providers, credentialing reps, and leadership for timely updates.
• Resolves discrepancies and issues impacting credentialing timelines.

Skills

Organizational skills

Problem solving

Time management

Interpersonal skills

Communication skills

HIPAA compliance

Remote work adaptability

Education

High School Diploma

Tools

Microsoft Word

Excel

Access

CAQH database

Job description

CommUnityCare is seeking a Credentialing Coordinator to manage credentialing and recredentialing for healthcare professionals across its health centers. Under the supervision of the Credentialing Manager, you will verify licensure and sanctions and maintain records in the credentialing database to ensure ongoing regulatory compliance.

Responsibilities include PSV, data entry, timely follow-up, and collaboration with providers, health plans, and leadership to resolve issues and submit required