Credentialing Coordinator

William F Ryan Community Health Cen•New York, NY

About The Position

The Credentialing Coordinator supports the Credentialing Manager with credentialing, re-credentialing, and provider enrollment functions. The role performs day-to-day credentialing and enrollment activities, maintains accurate records, and ensures timely processing of provider information in accordance with organizational policies and regulatory requirements, in support of Ryan Health’s mission and goals. Approximately 20% of the position’s time is devoted to administrative support for the Director of Executive Operations and the Executive Team. The position coordinates credentialing for new providers, including distributing applications, tracking submissions, conducting primary source verifications, preparing files and supporting Credentials Committee processes. It also supports provider enrollment with public and private payors, re-credentialing, regulatory and third-party submissions, maintenance of provider records and reporting, compliance, and audit preparation. Administrative support includes meeting coordination, routine office operations, communications, and maintaining Executive Team tracking tools. The role requires 0–2 years of credentialing, provider enrollment, or related healthcare administrative experience; relevant experience in another capacity in a health center or similar clinical setting may also be considered. Credentialing-specific knowledge is not required at hire. Education requirements are a bachelor’s degree and 1–2 years of relevant experience, or a high school diploma or GED and 3–5 years of relevant experience. The position has a 180-day introductory period. Work is primarily in a primary care ambulatory setting, where individuals’ behavior may be unpredictable and acute and chronic infectious diseases may be present.

Requirements

0–2 years of credentialing, provider enrollment, or related healthcare administrative experience; relevant experience in a health center or similar clinical setting in another capacity will be considered.
Bachelor’s degree and 1–2 years of relevant experience, or high school diploma or GED and 3–5 years of relevant experience.
Strong organizational skills, attention to detail, and ability to manage multiple priorities.
Effective written and verbal communication skills.
Ability to follow established procedures and escalate issues appropriately.
Professional, courteous, and responsive interactions with providers and internal stakeholders.
Commitment to accuracy and timeliness.
Ability to work effectively under the Credentialing Manager’s direction and collaborate with HR, clinical leadership, and administrative teams.
Ability to seek guidance when needed and communicate status proactively.

Nice To Haves

Familiarity with healthcare operations, regulatory environments, or administrative processes.
Experience with CAQH, PECOS, or similar credentialing or enrollment systems.
Experience in a federally qualified health center (FQHC) or similar setting.
Prior supervisory experience.

Responsibilities

Initiate credentialing for new providers after notification from Human Resources, including distributing credentialing packets and applications.
Track and follow up with providers to obtain complete credentialing materials in a timely manner.
Conduct primary source verification of licenses, certifications, and other required documentation according to credentialing policies.
Assist with preparation of delineation of privileges documentation.
Compile and organize credentialing files for review by the Credentialing Manager and Medical Director.
Assemble materials and track status for Credentials Committee review; assist with meeting scheduling and draft minutes as directed.
Support provider enrollment with Medicaid, Medicare, managed care organizations, and commercial payors.
Prepare and submit enrollment applications and supporting documentation under the Credentialing Manager’s direction; track status and follow up with payors.
Maintain documentation related to delegated credentialing arrangements, as applicable.
Monitor re-credentialing timelines, notify providers of upcoming requirements, collect and review materials, and prepare files for review and committee submission.
Help resolve routine credentialing and enrollment issues and escalate more complex matters to the Credentialing Manager.
Create and update provider profiles in CAQH and other required databases; assist with Medicaid and Medicare enrollment and revalidation submissions.
Maintain accurate NPI and provider data across systems and support enrollment in NCQA/PCMH systems, the 340B program, and other third-party platforms as directed.
Maintain credentialing records and files in accordance with Joint Commission, NCQA, and CAQH standards; enter and update provider data in credentialing software.
Assist with routine credentialing and enrollment reports and ensure accuracy and completeness across tracking tools and systems.
Follow organizational credentialing policies and regulatory requirements; support internal and external audit preparation and responses, including HRSA and Joint Commission reviews.
Maintain confidentiality and security of provider information.
Coordinate meetings for the Director of Executive Operations and Executive Team, including calendar invitations, logistics, and follow-up.
Provide administrative and logistical meeting support, including when the Director of Executive Operations is working remotely or out of the office.
Assist with routine office operations, including supplies, equipment service requests, mailings, deliveries, and courier services.
Prepare and distribute routine communications and materials on behalf of the Director of Executive Operations.
Maintain and update administrative schedules, lists, and other tracking tools used by the Executive Team.
Coordinate with internal staff and external vendors to support routine administrative needs.
Participate in special projects and perform other duties as assigned in support of the Credentialing function and Executive Team.