Summary:The
Credentialing Coordinator III is responsible for overseeing the end-to-end credentialing and re-credentialing process for providers within the El Camino Health Medical Network (ECHMN). This role partners strategically with the internal CVO to audit provider files, track credentialing timelines, and ensure all credentials and verifications are up-to-date and compliant with organizational policies and regulatory standards
The Credentialing Coordinator III supports the presentation of credentialing files for review and approval and works collaboratively with internal stakeholders and providers to maintain an efficient, compliant, and confidential credentialing process. This role also assists with provider data management, health plans delegation audits, CAQH profiles, and serves as a backup for related provider enrollment tasks.
Credentialing Process Management- Coordinate with the internal CVO to oversee, track credentialing and re-credentialing applications for all network providers.
- Audit the credentialing database regularly to ensure data integrity, compliance, and maintain accurate up-to-date records.
- Oversee the final quality control review of the credentialing files, ensuring the files meet standards requirements and organization policies before final approval.
- Upload provider credentialing renewals and supporting documentation into the database.
- Partner with the CVO to identify, troubleshoot, and resolve complex credentialing barriers and streamline the provider onboarding.
Provider Communication & Coordination- Serve as the senior point of contact for providers, delivering guidance and reminders for outstanding documentation or upcoming expirations.
- Follow up with providers to collect required documentation; respond to credentialing-related emails and requests.
- Assist the network providers in completing and updating CAQH profiles and ensure profile accuracy.
Committee & Reporting Support- Facilitate and attend credentialing committee preparation, including summaries, taking minutes and tracking post-committee action items.
- Assist the manager with provider enrollment tasks as assigned, including the preparation and initial formatting of provider rosters and credentialing reports.
- Support the manager during health plans delegation audits by pulling requested files, verifying NCQA compliance, and organizing audit evidence.
- Ensure all committee materials are prepared and submitted in a timely manner.
Administrative Support & Compliance- Maintain strict provider confidentiality and handle sensitive information with professionalism.
- Ensure all credentialing activities comply with HR, HIPAA, safety, and internal compliance policies.
- Mentor or provide peer guidance to junior credentialing staff on complex files and standard operating procedures.
- Support additional administrative tasks and cross-functional responsibilities within the credentialing and provider services team.
- Serve as the primary backup to the Credentialing and Provider Enrollment Supervisor.
Minimum RequirementsEducation: - High School diploma or GED; Associate's or Bachelor's degree preferred.
- Minimum of 3-5 years of experience in credentialing or provider data management within a healthcare setting.
Experience:- Familiarity with CAQH, credentialing software, and applicable accreditation standards (e.g., NCQA, CMS, Joint Commission).
- Certification as a Certified Provider Credentialing Specialist (CPCS) is highly preferred, or a strong willingness to obtain CPCS certification.
Other Knowledge, Skills, and Abilities:- Strong understanding of credentialing processes and regulatory compliance standards.
- Excellent attention to detail, strong organizational and time management,
- Ability to prioritize tasks, manage multiple files simultaneously, and meet strict operational deadlines.
- Proficient in Microsoft Office (Outlook, Word, Excel, Teams), credentialing databases and CAQH platforms
- Professional verbal and written communication skills; ability to work effectively with providers and internal departments.
- Ability to maintain confidentiality and professionalism in all interactions.
