Credentialing Coordinator

WILLIAM F RYAN COMMUNITY HEALTH CEN•New York, NY

1d•$70,000 - $75,000•Onsite

About The Position

The Credentialing Coordinator supports the Credentialing Manager in carrying out the organization’s 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. The coordinator initiates credentialing for new providers, tracks the collection and verification of required materials, organizes files for review, and supports Credentials Committee preparation and scheduling. The role also assists with provider enrollment and revalidation with public and commercial payors, maintains provider profiles and data across systems, and monitors re-credentialing timelines. The position maintains credentialing documentation and data in accordance with applicable standards, assists with routine reporting and audit preparation, protects confidential provider information, and escalates complex issues to the Credentialing Manager. The work is primarily in a primary care ambulatory setting. A 180-day introductory period applies.

Requirements

0–2 years of credentialing, provider enrollment, or related healthcare administrative experience; relevant experience in another capacity at a health center or similar clinical setting will be considered.
Bachelor’s degree and 1–2 years of relevant experience, or a 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 customer service, with a commitment to accuracy and timeliness.
Ability to work effectively under the direction of the Credentialing Manager and collaborate with HR, clinical leadership, and administrative teams.

Nice To Haves

Familiarity with healthcare operations, regulatory environments, or administrative processes; credentialing-specific knowledge is not required at hire.
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.
Perform primary source verification of licenses, certifications, and other required documentation in accordance with 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 by preparing and submitting applications and supporting documentation under the Credentialing Manager’s direction.
Track enrollment application status and follow up with payors; maintain documentation for delegated credentialing arrangements as applicable.
Monitor re-credentialing timelines, notify providers of upcoming requirements, collect and review materials, and prepare files for internal and committee review.
Support resolution of routine enrollment and credentialing 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 data accuracy and completeness across tracking tools and systems.
Follow organizational credentialing policies and applicable regulatory requirements; support internal and external audit preparation and responses, including HRSA and Joint Commission reviews.
Maintain confidentiality and security of provider information; participate in special projects and perform other duties as assigned.
Interact professionally, courteously, and responsively with providers and internal stakeholders; collaborate with HR, clinical leadership, and administrative teams, communicate status proactively, and seek guidance when needed.