Medical Staff Credentialing Coordinator

Sheppard Pratt Careers • Towson, MD

3d • Onsite

About The Position

Provides administrative and operational support for credentialing, recredentialing, and privileging behavioral health practitioners and clinical staff. Ensures timely and accurate processing of credentialing applications; maintains practitioner records and credentialing databases; and monitors license, certification, and other credential expirations. The role also supports managed-care credentialing and delegated payer audits.

Requirements

• One of the following education and experience combinations: a bachelor’s degree and 3 years of administrative, clerical, or office experience in a healthcare environment; an associate degree and 5 years of experience; or a high school education and 7 years of experience.
• Ability to maintain confidential and sensitive information.
• Proficiency in Microsoft Office applications, including Excel, Outlook, Teams, and Word.
• Strong attention to detail and accuracy in data entry and document management.
• Excellent verbal and written communication skills.
• Ability to interpret licenses, certifications, credentialing documents, and regulatory requirements.
• Strong organizational and time-management skills.
• Ability to work independently with minimal supervision.
• Experience maintaining databases and electronic records.
• Ability to maintain a professional demeanor and actively engage in virtual meetings conducted through video-conferencing platforms.
• Ability to prioritize workload, plan for cyclical and daily tasks, and meet deadlines.

Nice To Haves

• Experience or familiarity with behavioral health services.
• Working knowledge of TJC, NCQA, CARF, COMAR, and CMS credentialing, privileging, and regulatory requirements.

Responsibilities

• Provide quality services that meet the needs of clinicians and clinical and administrative leadership.
• Coordinate initial and reappointment credentialing applications and review applications for completeness and accuracy.
• Obtain and verify required credentials through primary-source verifications.
• Maintain electronic credentialing files in accordance with The Joint Commission (TJC) and State of Maryland requirements.
• Prepare files for Credentialing Committee review.
• Maintain the ECHO database for clinicians and generate reports, queries, letters, and lists as needed.
• Track expiring licenses, certifications, and insurance, and provide timely notices to clinicians and supervisors.
• Request temporary privileges and expedited privileging in accordance with policy.
• Compile State of Maryland updates every six months regarding physicians’ privileges.
• Participate in accreditation surveys and audits.
• Provide the Director with updates on the status of appointment and reappointment credentialing files.
• Work with Managed Care Credentialing Coordinators to ensure clinician files are complete for pre-delegation and annual delegated payer audits.
• Create and maintain an ECHO tracking mechanism for Managed Care Credentialing Coordinators.
• Provide documentation and respond to credentialing inquiries during managed-care delegated payer audits.

Benefits

• Professional development, including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation.
• Comprehensive medical, dental, and vision benefits for benefit-eligible positions.
• 403(b) retirement match.
• Generous paid time off for benefit-eligible positions.
• Complimentary Employee Assistance Program (EAP).
• Generous mileage reimbursement program.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED