Credentialing Coordinator

TEKsystems•Milwaukee, WI

8d•$20 - $20•Remote

About The Position

Build and maintain successful working relationships between the client and network practitioners to ensure a stable, qualified practitioner network. Facilitate practitioner activation and maintenance through initial credentialing, ongoing monitoring, and recredentialing in accordance with industry standards. Communicate with outsourced vendors, healthcare facility contacts and professionals, and internal staff to maintain detailed, compliant credentialing files. Work as part of the Credentialing Team to help the practitioner network meet or exceed quality, contract, and credentialing expectations and support quality improvement and risk management. Identify and document credentialing, compliance, and contract requirements as practitioners enroll, and create and maintain practitioner records in databases. Initiate credentialing, retrieve and verify applications and supporting documentation, follow up on outstanding materials, and ensure application completeness and data integrity for primary source verification and industry standards. Perform quality reviews during each credentialing cycle and facilitate complete, accurate recredentialing on a three-year cycle. Serve as a liaison between practitioners and internal departments to troubleshoot issues and answer questions. Monitor credentialed practitioners for accuracy and status changes, including regular internal record audits. Submit records to credentialing vendors or a Certified Verification Organization (CVO), as applicable, and review completed files. Facilitate and record credentialing committee meetings for files requiring review, notify practitioners of decisions, submit background checks to contracted vendors and review reports, and update practitioner statuses according to committee decisions. A typical day includes managing a shared inbox, reviewing workload and follow-up items, processing new credentialing cases, responding to practitioner emails, supporting the credentialing call queue, handling inbound and outbound calls, and updating records and case statuses. The role handles approximately 15–20 calls per day; calls may interrupt ongoing work, making flexibility and prioritization important. This is a fully remote contract position based out of Milwaukee, Wisconsin.

Requirements

Associate degree in Health Information Technology, Business, or a related field; healthcare emphasis preferred, combined with at least one year of credentialing or healthcare experience. Equivalent combinations of education, experience, and/or applicable military experience will be considered.
Knowledge of healthcare terminology and electronic file/database management.
Proficient telephone skills.
Database experience.
Proficiency with Microsoft Office programs.
Excel experience, including spreadsheet creation and use of basic functions and formulas.
Proficiency working with electronic files and documents.
Ability to perform detailed work with a high degree of accuracy.
Ability to think analytically, multitask, and manage time effectively.
Ability to work independently and as part of a team.
Ability to navigate multiple websites and databases.
Ability to demonstrate appropriate assertiveness while performing responsibilities under tight deadlines.
Strong analytical, organizational, multitasking, and time-management skills.
Excellent professional verbal and written communication skills, including the ability to communicate effectively with diverse individuals and teams at all organizational levels.
Excellent problem-solving skills and ability to propose solutions in a fast-paced environment.
Ability to manage time effectively and reprioritize work as internal and external customer needs change.

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) certification through the National Association Medical Staff Services.
National Career Readiness Certificate.
Familiarity with NCQA credentialing standards.
Knowledge of practitioner credentialing and primary source verification of medical or dental licensure.

Responsibilities

Build and maintain working relationships between the client and network practitioners.
Perform initial credentialing, ongoing monitoring, and recredentialing for network practitioners in accordance with industry standards.
Communicate with outsourced vendors, healthcare facility contacts and professionals, and internal staff to maintain compliant practitioner credentialing files.
Identify and document credentialing, compliance, and contract requirements as practitioners enroll; create and maintain practitioner database records.
Initiate credentialing cases; retrieve, verify, and follow up on applications and supporting documents.
Ensure applications are complete and database information is accurate for primary source verification and industry standards.
Perform quality reviews of credentialing files throughout each credentialing cycle.
Monitor and facilitate accurate recredentialing on a three-year cycle.
Liaise between practitioners and internal departments to troubleshoot issues and respond to questions or concerns.
Monitor practitioner records for accuracy and status changes, including regular internal audits.
Submit practitioner records to a CVO or other credentialing vendor when applicable, and retrieve and review completed files.
Schedule and facilitate credentialing committee meetings, record meeting outcomes, and notify practitioners of decisions.
Submit required practitioner background checks to a contracted vendor and review completed reports.
Update practitioner statuses based on credentialing committee decisions.
Manage a shared inbox, review workload and follow-up items, process new cases, respond to practitioner emails, and support the credentialing call queue.
Handle inbound and outbound phone calls, approximately 15–20 per day, and update records and case statuses.

Benefits

Medical insurance, if eligible.
Dental insurance, if eligible.
Vision insurance, if eligible.
Critical illness, accident, and hospital coverage, if eligible.
401(k) retirement plan with pre-tax and Roth post-tax contributions available, if eligible.
Voluntary life and AD&D insurance for employees and dependents, if eligible.
Short- and long-term disability coverage, if eligible.
Health Spending Account (HSA), if eligible.
Transportation benefits, if eligible.
Employee Assistance Program, if eligible.
Time off/leave, including PTO, vacation, or sick leave, if eligible.