Job Description
Job Description
The Credentialing Coordinator with auditing experience is responsible for managing and maintaining provider credentialing and recredentialing processes while ensuring compliance with regulatory, accreditation, and organizational standards. This role includes auditing credentialing files, verifying provider documentation, identifying compliance gaps, and supporting quality assurance initiatives within healthcare organizations, insurance networks, or medical groups.
Key Responsibilities
- Coordinate provider credentialing and recredentialing processes for physicians, nurses, and allied health professionals.
- Verify licenses, certifications, education, work history, malpractice coverage, and other required documentation.
- Maintain accurate provider records in credentialing databases and tracking systems.
- Conduct internal audits of credentialing files to ensure compliance with:
- NCQA standards
- State and federal guidelines
- Identify missing or expired credentials and follow up with providers for updates.
- Prepare audit reports and recommend corrective actions when deficiencies are identified.
- Monitor credential expiration dates and ensure timely renewals.
- Assist during external audits and accreditation reviews.
- Ensure confidentiality and accuracy of sensitive provider information.
- Generate & maintain reports related to credentialing status, audit findings, and compliance metrics.
Qualifications
- Minimum 1 year of credentialing experience in a healthcare environment.
- Experience conducting credentialing audits or compliance reviews preferred.
- Knowledge of NCQA, CMS and credentialing regulations.
- Proficiency with credentialing software and Microsoft Office Suite.
- Strong attention to detail and organizational skills.
- Excellent written and verbal communication skills.
- Ability to manage deadlines and handle multiple projects simultaneously.
Skills
- Credential verification
- Compliance auditing
- Data accuracy and record management
- Analytical and problem-solving skills
- Time management
- Report preparation
- Regulatory compliance knowledge
Company DescriptionS&S Management Inc is a Management Services Organization (MSO).
Company Description
S&S Management Inc is a Management Services Organization (MSO).