Credentialing Coordinator

Job Title: Credentialing Coordinator

Location: Portland, OR (Remote Locals only)

Duration: 02 Months Contract

Job Description:

Education:

GED/High School Graduation

Experience:

High School Diploma or GED required and 3 years medical staff credentialing experience in a health care or insurance practitioner setting

OR associate s degree and 3 years experience performing data collection or data analysis using complex database software systems

OR a combination of education and experience.

Job responsibilities:

• Review and process applications for providers who are joining or renewing their credentials. Follow established policies and make sure everything meets required standards.
• Apply knowledge of state and federal regulations, as well as organizational and accreditation requirements (like DNV, TJC, and NCQA), to ensure every application is compliant.
• Identify and look into any issues or missing information (like discrepancies or negative findings) in applications or verification results, and confirm accuracy before moving forward.
• Communicate regularly with internal teams and external contacts to keep applications moving and ensure timely completion.
• Maintain organized and confidential credentialing files for each provider, including sensitive peer review information.
• Follow up consistently on incomplete applications, gather required documentation, and complete necessary checks (such as license verifications and database searches like OIG, Opt-Out, and NPDB).
• Track application progress, follow up on missing items, and secure approvals so that all provider records are complete, accurate, and up to date before final review.
• Manage and update credentialing data in internal systems, including new applications, renewals, privilege changes, and status updates.
• Document each step of the credentialing process clearly and keep records updated daily from application start through completion..