Provider Credentialing Coordinator

About the Role

We are seeking a detail-oriented and highly organized Provider Credentialing Coordinator to manage the credentialing, recredentialing, privileging, and payer enrollment processes for Psychiatrists, PMHNPs, and other healthcare providers.

This role ensures providers meet all regulatory, licensing, and payer requirements while maintaining accurate records and supporting ongoing organizational compliance. The position requires strong attention to detail, excellent follow-up skills, and experience working within healthcare credentialing workflows.

Key Responsibilities

Provider Credentialing & Compliance

• Manage and track all phases of provider credentialing, recredentialing, privileging, and payer enrollment processes.
• Ensure compliance with requirements from regulatory agencies, accreditation bodies, state licensing boards, and insurance payers.
• Responsible for Data entry and maintaining provider information in online credentialing databases and system (Verifiable, CAQH, PECOS, and NPPES)  
• Serve as the primary point of contact for providers regarding credentialing and enrollment requirements.
• Collect, verify, and maintain all required provider documentation (licenses, certifications, malpractice insurance, education, training, and work history).
• Track license and certification expirations to ensure timely renewals and ongoing compliance.
• Prepare, submit, and monitor credentialing and payer enrollment applications to ensure timely processing.
• Follow up with licensing boards, insurance carriers, and external agencies to resolve application issues and expedite approvals.
• Monitor application status and proactively follow up with payers until providers receive confirmation of in-network participation.
• Responsible for revalidation requests issued by government payers  
• Maintain payer-specific credentialing knowledge, requirements, and application processes.
• Identify and resolve discrepancies, delays, or incomplete credentialing applications.
• Troubleshoot any payer-related issues
• Provide regular status updates and reports on credentialing activities and provider enrollment progress.
• Support audits, compliance reviews, and accreditation requirements as needed.
• Identify process improvement opportunities to enhance credentialing efficiency and accuracy.
• Ensure adherence to internal policies and external regulatory standards at all times.
• Conduct research and verification activities to gather and validate provider information as needed.

Qualifications

Required Education and Experience

• Bachelor’s degree in Healthcare Administration, Business Administration, or related field preferred.
• 2–3 years of experience in healthcare credentialing, provider enrollment, medical staff services, or related administrative function.
• Direct experience with provider credentialing and payer enrollment required.

Skills and Competencies

• Strong knowledge of healthcare credentialing standards, payer enrollment processes, and regulatory requirements.
• Exceptional organizational skills and high attention to detail.
• Experience using provider credentialing and enrollment platforms.
• Preferred experience with Verifiable credentialing software.
• Working knowledge of CAQH, Availity, and Provider Express.
• Experience managing provider enrollment, credentialing, recredentialing, and payer-related documentation.

• Familiarity with NCQA, Joint Commission, CMS, Medicare, and commercial payer requirements preferred.
• Strong written and verbal communication skills.
• Ability to manage multiple deadlines and priorities independently.
• High level of confidentiality and professionalism when handling sensitive provider data.
• Proficiency in Microsoft Office Suite (Outlook, Excel, Word, PowerPoint).
• Strong problem-solving and follow-up skills in a fast-paced environment.