The Credentialing Coordinator is responsible for ensuring provider credentialing activities comply with NCQA, URAC, Medicare, Medicaid, delegation agreements, health plan contracts, and applicable state and federal regulations.
This position supports the credentialing and provider enrollment process by verifying clinician credentials, maintaining accurate provider files, coordinating licensing and enrollment activities, and ensuring all documentation meets established quality and compliance standards.
Key Responsibilities
Verify state licenses, DEA registrations, board certifications, exclusion lists, and Medicare/Medicaid enrollment on an ongoing basis.
Ensure clinicians remain qualified, compliant, and approved to participate in the provider network.
Enroll clinicians in Medicare and Medicaid according to applicable state and federal requirements.
Assist with and coordinate state licensure applications for clinicians.
Monitor provider credentialing files for completeness, accuracy, and compliance.
Review documentation against quality standards, accreditation requirements, internal policies, and client requirements.
Enter, update, and maintain provider information in the credentialing database with a high level of accuracy.
Prepare, issue, electronically track, and follow up on credentialing verifications.
Manage a high-volume workload while meeting strict credentialing timelines.
Communicate professionally with providers, internal departments, external clients, and other stakeholders regarding credentialing-related questions and issues.
Maintain strong working relationships with Recruiting, Production, Education, and other internal teams.
Stay current with healthcare regulations, credentialing standards, and applicable legislation.
Participate in special projects and other credentialing-related initiatives as needed.
Required / Preferred Qualifications
Previous experience in healthcare provider credentialing or provider enrollment.
Experience with state licensure and license verification is highly preferred.
Experience with CAQH preferred.
Experience with MD-Staff/MDStaff preferred.
Knowledge of Medicare and Medicaid provider enrollment.
Familiarity with NCQA and/or URAC credentialing standards.
Experience verifying DEA registrations, board certifications, exclusions/sanctions, and provider credentials.
Strong attention to detail and organizational skills.
Ability to manage multiple credentialing files and meet strict deadlines.
Strong written and verbal communication skills.
Proficiency with Google Workspace/Google Suite preferred.
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.