Medical Staff Credentialing and Provider Enrollment Coordinator

Summary

The Medical Staff Credentialing and Provider Enrollment Coordinator is responsible for executing all aspects of medical staff credentialing and provider enrollment to ensure compliance with organizational policies, Medical Staff Bylaws, and regulatory and accreditation standards. This role processes appointments, reappointments, privileging requests, temporary privileges, leave of absences, staff category changes, name changes, resignations, and all provider enrollment, re-verification, and terminations with federal, managed care, and other third-party payors.

The coordinator partners with physician and administrative leaders to develop, draft, and maintain clinical privileging criteria, ensures timely and accurate enrollment activities, and supports organizational readiness for reimbursement, audits, accreditation, and regulatory reviews. Additionally, the role maintains up-to-date knowledge of regulatory requirements, applies best practices to credentialing and enrollment processes, and assists with accreditation and regulatory survey preparation.

Education

Required: High School diploma or GED, and a minimum of three years related experience.

Certification, Registration & Licensure

None required.

Experience

Minimum of three years related experience and proficiency in Microsoft Office applications, including Word and Excel; experience with credentialing systems, CAQH, and web portals for insurance enrollment; knowledge of billing; familiarity with accreditation organizations and their standards; and a high level of data-entry accuracy. Prior experience in Medical Staff Credentialing and Provider Enrollment is strongly preferred.
 

Responsibilities

• Manage and perform comprehensive credentialing and privileging processes for practitioners, including initial applications, reappointments, temporary privileges, leave of absence requests, additional privilege requests, staff category changes, and resignations.

• Conduct critical analysis of all credentialing and privileging applications to verify eligibility, flag areas of concern, and resolve discrepancies in alignment with organizational standards.

• Maintain accurate and up-to-date internal and electronic files, databases, and tracking logs for credentialing, privileging, and provider enrollment, ensuring integrity and proper documentation throughout the process.

• Provide administrative and meeting support for the Credentials Committee and Medical Executive Committee (MEC), including preparation, documentation, and follow-up of actions and decisions.

• Process and maintain all aspects of provider enrollment and re-enrollment with federal, state, and commercial payors for practitioners and institutional groups, including initial enrollment, revalidations, updates, terminations, including provider directory and CAQH review and updates. Ensure timely and accurate submission of enrollment applications, re-enrollment forms, and supporting documentation.

• Respond to and resolve issues related to provider network participation, including eligibility, denials of services, and reimbursement discrepancies, acting as a liaison between providers, hospital staff, and payor representatives.

• Develop and maintain positive relationships with internal and external stakeholders, including practitioners, leadership, payors, government, and regulatory agencies, and ensure the timely resolution of inquiries and complex issues.

• Ensure compliance with all applicable regulatory, accreditation, and payor standards, including CMS, NCQA, and other federal and state requirements.

• Recommend and help implement process improvements and best practices to enhance operational efficiency and compliance.

• Assist with accreditation and regulatory survey readiness for credentialing functions.

• Manage expirables, including tracking, follow-up, and timely updates; complete monthly reporting and end-of-month processes to ensure accuracy and compliance.

• Provide backup support to colleagues and perform other duties as assigned.

Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.

Know Your Rights: Workplace Discrimination is Illegal

Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269.

Physical and Work Requirements
The physical demands and characteristics of the work environment described here are representative of those an employee will encounter in successfully performing the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Dictionary of Occupational Titles Material Handling Classification is LIGHT. The employee must regularly lift, carry or push/pull less than 10 pounds, frequently lift, carry or push/pull up to 10 pounds, and occasionally lift, carry or push/pull up to 20 pounds.

The employee is frequently required to hear and perform activities that require fine motor skills, reach, sit, and speak. The employee is occasionally required to do repetitive motion, and walk.

Specific vision abilities required by this job include color vision, depth perception, far vision, near vision, and peripheral vision.

The noise level in the work environment is usually quiet.