Position Overview:

The Credentialing Coordinator supports the Credentialing Manager in the implementation of the organization’s credentialing, re-credentialing, and provider enrollment functions. This role is responsible for executing day-to-day credentialing and enrollment activities, maintaining accurate records, and ensuring timely processing of provider information in accordance with organizational policies and regulatory requirements. This work is carried out in support of the mission and goals of Ryan Health.

 

Essential Functions:

Credentialing of New Providers

• Upon notification by Human Resources (HR) of a new hire, initiate credentialing process, including distribution of credentialing packets and applications.


• Track and follow up with providers to ensure timely submission of complete credentialing materials.


• Perform primary source verification of licenses, certifications, and other required documentation in accordance with credentialing policies.


• Assist in preparation of delineation of privileges (DOP) documentation.


• Compile and organize credentialing files for review by the Credentialing Manager and Medical Director.


• Support preparation of materials for Credentials Committee review, including assembling files and tracking status.


• Assist with scheduling of Credentials Committee meetings and preparation of draft minutes, as directed.


• Provider enrollment.


• Support enrollment of providers with Medicaid, Medicare, managed care organizations, and commercial payors.


• Prepare and submit enrollment applications and supporting documentation under direction of the Credentialing Manager.


• Track application status and follow up with payors to ensure timely processing.


• Maintain documentation related to delegated credentialing arrangements, as applicable.

Re-credentialing and Maintenance

• Monitor re-credentialing timelines and notify providers of upcoming requirements.


• Assist with collection and review of re-credentialing materials.


• Prepare re-credentialing files for internal review and committee submission.


• Support resolution of routine enrollment and credentialing issues, escalating more complex matters to the Credentialing Manager.

 

Third-Party and Regulatory Submissions

• Create and update provider profiles in CAQH and other required databases.


• Assist with Medicaid and Medicare enrollment and revalidation submissions.


• Maintain accurate NPI and provider data across systems.


• Support provider enrollment in NCQA/PCMH systems, 340B program, and other third-party platforms as directed.

Reporting, Documentation & Systems

• Maintain credentialing records and files in accordance with Joint Commission, NCQA, and CAQH standards.


• Enter and update provider data in credentialing software systems.


• Assist in preparation of routine reports on credentialing and enrollment activity.


• Ensure data accuracy and completeness across all tracking tools and systems.

Policies, Procedures & Compliance

• Adhere to organizational credentialing policies and applicable regulatory requirements.


• Support audit preparation and responses for internal and external reviews (e.g., HRSA, Joint Commission).


• Maintain confidentiality and security of provider information.


• Participate in special projects and perform other duties as assigned in support of the Credentialing function.