Credentialing Coordinator

Springfield, MA

Position Title:                        Credentialing Coordinator

General Description:


The Credentialing Coordinator ensures that all Caring Health Center providers who are independently licensed and who are in the medical, dental or behavioral health departments are fully credentialed and privileged by the Caring Health Center Board of Directors and are fully credentialed with the health insurance companies with which CHC conducts business. 

Reports to:     Chief Human Resources Officer

Supervises:     N/A

Salary/Status: Non-Exempt

Minimum Requirements:

  1. Associates’ degree in Business, Healthcare or related field
  2. Prior experience in Credentialing
  3. Strong oral and written communication skills.
  4. Able to work independently.
  5. Organized, with excellent attention to detail.
  6. Knowledge of commercial health insurance industry and industry practices.
  7. Ability to maintain confidential information.

Principle Responsibilities and Duties:

  1. Oversee all primary and secondary source verification activities
  2. Track license, certification, DEA, and controlled substance registration expirations for each provider and ensure timely renewals
  3. Ensure new clinicians are scheduled for review at the Staff Credentialing Committee meeting and existing physicians are re-credentialed in a timely manner 
  4. Ensure timely processing of clinicians into CAQH system
  5. Ensure new providers and other professional medical staff files are complete and contain all necessary applications and licenses relative to the credentialing and privileging process
  6. Complete all privileging and credentialing applications with all insurers to maintain Caring Health Center ’s ability to collect reimbursements
  7. Maintain all credentialing and privileging files in accordance with CHC, HRSA, and other regulatory bodies
  8. Work closely with Massachusetts Board of Registration in Medicine, MCSR, DEA,  insurance carriers, and other licensing bodies in resolving any issues that may arise with credentialing, privileging, or appointment/reappointment of Caring Health Center  providers
  9. Process credentialing applications and reappointment paperwork, checking for full completeness and accuracy
  10. Process applications, reappointment paperwork, and maintain records and databases pertinent to credentialing
  11. Constantly collect and process significant amounts of verification and other information and must constantly maintain and update accurate databases -  these databases include pertinent education information, training, CEU’s, experience, and licensure content .
  1. Prepare own records for regular auditing
  1. Assists in Quality Assurance and Risk Management activities.
  1. Assists with Human Resources functions as needed

This position requires compliance with Caring Health Center’s compliance standards, including its Standards of Conduct, Compliance Program, and policies and procedures. Such compliance will be an element considered as part of the Credentialing Coordinator’s regular performance evaluation.

From time to time, this position requires the ability to work long and arduous hours.

JOB CODE: 1000072