[Hiring] Credentialing Coordinator @Connections Health Solutions

Role Description

Under the direction of the Director, RCM Implementation, the Credentialing Coordinator manages the end-to-end credentialing, re-credentialing, and payer enrollment process for behavioral health providers, behavioral health support (BHS) staff, and facilities across Connections Health Solutions (CHS). This role serves as the subject matter expert for credentialing requirements across licensed clinical providers and non-licensed behavioral health support staff, ensuring accurate, timely, and compliant credentialing files that support billing, payer enrollment, and delegation of authority obligations.

• Provider Onboarding & Data Entry: Manages new provider onboarding from initial HR/Talent Acquisition notification through completion of the provider’s Medallion profile. Enters and maintains provider information, including NPI, licensure, practice locations, and payer information, using the provider’s CV and supporting documentation.
• Provider Communication: Initiates and tracks onboarding communications with providers to request required documentation, including CAQH, PECOS, state licenses, DEA registrations, board certifications, diplomas, and other required credentials. Conducts timely follow-up to ensure provider profiles reach 100% completion.
• Verbal Provider Support: Initiates and responds to phone calls and text messages with physicians and other providers to explain credentialing and enrollment requirements, resolve outstanding items, and answer questions when direct communication is needed to keep the credentialing process moving forward.
• Provider Licensing Research: Researches and interprets state licensing board requirements across provider types, including MDs, DOs, NPs, and PAs, to determine applicable licensure, supervision or collaborative agreement, and scope-of-practice requirements by market. Maintains current knowledge of regulatory and licensing board changes that may impact credentialing.
• Primary Source Verification (PSV): Monitors and completes required primary source verifications within the credentialing platform, including NPI, NPDB, Medicare/Medicaid opt-out, state licensure, DEA, OIG, and SAM checks. Escalates adverse findings through the appropriate credentialing committee review process prior to the provider’s start date.
• Malpractice & Insurance Coordination: Coordinates with the organization’s insurance broker to add new providers to the applicable malpractice policy. Uploads resulting facesheets, certificates, and other required documentation to the credentialing platform and CAQH.
• Payer Enrollment & Maintenance: Manages provider enrollment with applicable commercial and government payers by market. Monitors applications through completion, escalates stalled or non-compliant applications, and verifies effective dates, payer IDs, and recredentialing dates are accurately documented following approval.
• CAQH & Attestation Management: Maintains and re-attests provider CAQH profiles, ensuring practice locations, liability coverage, and other required information remain current and accurate for payer enrollment.
• Multi-State & Telehealth Licensing: Supports cross-state licensure and payer enrollment for telehealth providers, including updates to practice location and licensure information and coordination of additional malpractice insurance coverage for new markets.
• State-Specific Registration Processes: Facilitates state and program-specific registration requirements, including prescriptive authority and collaborative agreement registration for advanced practice providers, state Medicaid portal enrollment, domain transfers, surrogacy requests, and Medicare enrollment through CMS/PECOS.
• BHS Staff Credentialing: Manages NPI acquisition and state Medicaid enrollment for applicable behavioral health support staff. Tracks enrollment status through supplemental tracking tools and distributes recurring compliance reports, including missing NPI and Medicaid enrollment information, to HR and operational leadership for follow-up.
• Facility Credentialing: Manages facility-level enrollment and maintenance within applicable state Medicaid systems, including linking servicing providers to facility records and maintaining accurate facility enrollment information.
• Offboarding: Processes provider and BHS staff terminations by deactivating credentialing platform profiles and notifying applicable payers of provider departures in accordance with market-specific requirements.
• Ongoing Maintenance & Recredentialing: Performs routine monitoring of OIG/SAM and NPDB databases and tracks provider recredentialing cycles, typically every three years. Monitors license and board certification renewal requirements and completes necessary updates to prevent credentialing or enrollment lapses.
• Delegation of Authority: Completes credentialing documentation under applicable delegation of authority requirements and ensures activities remain compliant with delegated credentialing agreements.
• Cross-Functional Collaboration: Partners with Human Resources, Talent Acquisition, Medical Leadership, and operational leadership to facilitate timely provider onboarding, resolve credentialing or compliance issues, and support new-hire orientation timelines.
• Committee Participation & Reporting: Participates in quarterly Credentialing Committee meetings and prepares regular reporting on provider, BHS staff, and facility credentialing and enrollment status for Revenue Cycle Management (RCM) and operational leadership.
• Process Documentation: Supports the development, implementation, and maintenance of standardized credentialing workflows, reference guides, process documentation, and Standard Operating Procedures (SOPs).
• Performs other duties and responsibilities as assigned to support organizational and departmental objectives.

Qualifications

• High school diploma or equivalent required
• 2 years of experience in provider and/or facility credentialing, payer enrollment, or related managed care administrative work
• General knowledge of regulatory requirements related to credentialing and payer enrollment, including a solid understanding of Medicare, Medicaid, and managed care processes and rules
• Ability to research and interpret state licensing board requirements across provider types (MD, DO, NP, PA) and apply them accurately to credentialing decisions
• Experience working within a credentialing software platform (e.g., Medallion) or comparable credentialing management system
• Working knowledge of provider enrollment systems such as PECOS, CAQH, and state Medicaid provider portals
• Strong customer service orientation and soft skills, with comfort communicating by phone or text with physicians and providers to resolve credentialing questions and outstanding items, in addition to email-based correspondence.
• Advanced user of Microsoft Office products, particularly Excel.

Requirements

• The Company has a mandatory vaccination policy. All successful applicants must be fully vaccinated, including showing proper documentation, or otherwise be exempt pursuant to the Company’s exemption process prior to their start date as a condition of employment.

Benefits

• Full-time only: Employees (and their families) are offered comprehensive health insurance, including Medical, Dental, Vision, Accident, Critical Illness, and Hospital Indemnity
• CHS pays for Basic Life, AD&D, Short and Long-Term Disability
• Voluntary Life insurance option for employees and their families
• Health Savings Accounts (with $1,000 to $2,000 employer contribution depending on plan)
• Flexible Spending Accounts (health care and dependent care)
• 401k company match after 6 months (50% of deferrals up to 6% of compensation)
• Generous PTO starting at 160 hours accrued annually and 12 recognized company holidays
• Company‑paid parental leave available to eligible employees
• All employees (Pool, Part-time and Full-time): Employee Assistance Program to help with confidential emotional support, work life solutions, financial solutions, legal assistance, or online support
• After 90 days, you are auto enrolled in the 401k Plan