Credentialing Coordinator

Codman Square Health Center Inc • Boston, MA

15h • $54,080 - $84,261

About The Position

Codman Square Health Center (CSHC), a Federally Qualified Health Center serving Dorchester, Massachusetts, and surrounding neighborhoods, seeks a Credentialing and Enrollment Coordinator. The role ensures provider files are current and maintained to meet compliance standards and responds promptly to requests from privileging and enrollment partners for provider-specific information.

The coordinator supports provider onboarding and privileging, insurance enrollment, provider file management, reporting, reimbursement processing, maintenance of insurance provider contract files, and enrollment in prior authorization systems. The position also serves as a backup to the COO’s executive assistant.

Requirements

• Strong time-management and organizational skills, attention to detail, and commitment to quality.
• Ability to prioritize duties and meet deadlines for multiple clients.
• Ability to interact professionally and effectively with staff at all levels, leadership, providers, and outside parties.
• Working knowledge of NCQA, Medicaid, and other regulatory requirements.
• Excellent customer service skills.
• Knowledge of medical credentialing and privileging procedures and standards.
• Ability to function independently and perform routine department procedures without supervision.
• Proven ability to maintain sensitive and confidential information.
• Strong written and verbal communication skills.

Responsibilities

• Coordinate with the medical staff hiring committee to document new medical staff hires.
• Collect provider contact information and submit data to the privileging and appointment partner, Boston Medical Center (BMC).
• Provide new provider hires with a welcome onboarding letter outlining process expectations, timelines, and points of contact.
• Follow up with BMC to confirm provider profiles are established and applications are sent to providers for initial appointments.
• Act as the primary liaison between BMC and providers when BMC cannot reach a provider about application requests by email.
• Monitor the shared web tracking system for application updates and missing documentation.
• Report to the medical staff committee when a provider has been approved by the appointment board.
• Notify Credentialing Administrative Services (CAS) of new providers and submit provider data collection forms.
• Collect and submit documents required for provider insurance enrollment.
• Monitor enrollment progress and notify the provider, medical staff committee, and Human Resources when the insurance enrollment threshold is met.
• Provide CAS with updates regarding provider terminations.
• Review provider applications for completeness, identify credentialing concerns, and request follow-up information from providers or other sources as needed.
• Maintain the quality and integrity of provider files in accordance with applicable governing agencies and internal quality and security policies, including paper and electronic document management.
• Generate routine reports to track verification timeliness, re-credentialing dates, and expired-document processing.
• Process approved provider reimbursements, including certifications, membership dues, and continuing medical education expenses.
• Maintain insurance provider contract files.
• Identify credentialing and enrollment issues, including lapses, and escalate them as necessary to ensure compliance.
• Work with BMC to enroll providers in the prior authorization system.
• Serve as backup to the COO’s executive assistant.

Benefits

• Competitive medical and dental insurance.
• Employer-paid life, accidental death and dismemberment, and long-term disability insurance.
• Retirement 403(b) plan.
• Vacation, holiday, personal, and sick time accruals.
• Flexible spending reimbursement accounts for health and dependent care.
• Educational assistance and tuition reimbursement programs.
• Commuter benefits.
• Opportunities for academic appointment at Boston University or Boston Medical Center.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed