Credentialing & Project Coordination Specialist
About the role Position Summary The Credentialing & Project Coordination Specialist is responsible for supporting provider credentialing, payer enrollment, and provider onboarding activities while serving as a key operational partner to the Strategic Initiatives team. This role ensures providers are credentialed and enrolled accurately and timely while coordinating project activities, tracking deliverables, facilitating communication, and supporting implementation of strategic organizational initiatives. The ideal candidate is highly organized, detail-oriented, and capable of managing multiple priorities across provider operations, credentialing, payer relations, and project management functions in a value-based primary care environment. What you'll do
Key Responsibilities
Provider Credentialing, Recredentialing & Payer Enrollment · Manage initial credentialing and recredentialing for all providers across contracted health plans. · Prepare and submit credentialing applications through payer portals and credentialing platforms (e.g., CAQH). · Track credentialing status and follow up with payers to ensure timely approvals. · Maintain accurate provider credentialing files including licenses, certifications, malpractice insurance, and other required documentation. · Monitor credential expiration dates and ensure timely renewals. · Maintain records of all payer participation status and effective dates. · Support provider onboarding to ensure enrollment is completed prior to seeing patients when required. · Provide updates to leadership on credentialing timelines and payer approvals. · Identify and escalate delays that may impact provider start dates or billing. Provider Directory Management · Ensure provider information is accurate and updated across payer directories. · Submit roster updates and demographic changes to payers. · Work with internal teams to maintain consistent provider information across systems. Compliance & Documentation · Maintain credentialing files in accordance with regulatory and accreditation requirements. · Support audits related to provider credentialing and payer enrollment. · Ensure compliance with internal policies and payer requirements. Project Coordination & Strategic Initiatives Support · Support the Strategic Initiatives Project Manager in planning, executing, and monitoring cross-functional projects. · Maintain project plans, timelines, meeting notes, action logs, and status reports. · Coordinate project meetings, prepare agendas, document decisions, and track follow-up actions. · Develop and maintain project documentation, SOPs, process maps, and implementation materials. Process Improvement & Operational Support · Identify opportunities to improve credentialing, onboarding, and provider operations workflows. · Assist in developing standardized processes, templates, and tracking tools. · Support reporting and analysis related to credentialing performance, enrollment status, and project progress. · Maintain organizational project repositories, trackers, and documentation libraries. · Participate in special projects and organizational initiatives as assigned.
Qualifications
Required · Bachelor’s degree in Healthcare Administration, Business, or related field preferred. · 2+ years of experience in provider credentialing or payer enrollment. · Experience working with Medicare Advantage, Medicare, and Medicaid plan enrollment processes. · Knowledge of provider credentialing and payer enrollment processes. · Strong organizational and project coordination skills. · Proficiency with Microsoft Office Suite, including Excel, PowerPoint, and Outlook. · Excellent written and verbal communication skills. · Strong attention to detail and ability to manage multiple priorities simultaneously. Preferred · Experience in value-based care, primary care, or multi-site provider organizations. · Experience using credentialing software, CAQH, payer portals, and provider enrollment systems. · Familiarity with project management methodologies and tools · Experience with SharePoint and Power BI. Reports To: Senior Associate, Strategic Initiatives Apply To This Job