Credentialing Coordinator

WellPower - All Jobs•Denver, CO

18h•Hybrid

About The Position

The Credentialing Coordinator is responsible for managing and maintaining the credentialing and re-credentialing process for healthcare providers, interns/students/residents and volunteers to ensure compliance with regulatory standards, accreditation requirements, and organizational policies. This role ensures that all WellPower Medical Staff meet the qualifications and maintain active status with insurance networks and governing bodies while also developing and maintaining a working knowledge of relevant statues and laws.

Requirements

High School Diploma or GED.
2+ years of medical credentialing and /or provider enrollment experience

Nice To Haves

Associate's degree in healthcare administration, business, or relevant work preferred

Responsibilities

Collect, verify, and process provider documentation including but not limited to licenses, certifications, education, work history, and malpractice history.
Submit applications to insurance payers and monitor approval status.
Maintain accurate and up-to-date credentialing files in compliance with NCQA, HRSA, CMS, and state regulations.
Ensure adherence to organizational policies, federal and state regulations, and accreditation standards.
Track expiration dates for licenses, certifications, and other credentials; notify providers of upcoming renewals.
Verify all renewal information and update the provider credentialing file
Maintain credentialing database and provider records with high accuracy.
Generate reports for leadership and assist with audits as needed.
Maintain CAQH and NPI profiles for providers
Serve as a liaison between providers, insurance companies, and internal departments.
Perform other duties as assigned
Maintain a trauma informed environment of wellbeing.
Other duties as assigned