Credentialing Analyst / Coordinator III {177284}

Job Title: Credentialing Analyst / Coordinator III
Location: Hybrid – 02864
Schedule: Monday–Friday, 8:00 AM–4:30 PM ET
Pay Rate: Up to $24.65/hour

Job Overview

We are seeking a detail-oriented Credentialing Analyst / Coordinator III to support provider credentialing and re-credentialing activities for nurse practitioners, physician assistants, behavioral health providers, and physicians. This role is responsible for maintaining accurate provider records, monitoring expiring credentials, conducting compliance checks, and ensuring adherence to Joint Commission, NCQA, and URAC credentialing standards.

The ideal candidate has at least three years of healthcare credentialing experience, strong analytical skills, and proficiency with MDStaff and Microsoft Office applications.

Key Responsibilities

• Process initial credentialing and re-credentialing applications for NPs, PAs, physicians, and behavioral health providers accurately and within established timelines.
• Perform primary source verification, sanctions screening, compliance monitoring, and expirable credential management.
• Monitor expired licenses, maintain credentialing databases, update provider records, and prepare weekly reports for leadership.
• Manage Epic access for providers with noncompliant licenses or board certifications.
• Conduct compliance reviews and escalate undisclosed negative findings to the appropriate management teams.
• Verify malpractice insurance coverage according to internal policies.
• Maintain provider and physician SharePoint sites, credentialing grids, and electronic provider files.
• Communicate provider status updates to leadership and internal teams to ensure timely processing.
• Submit system access requests following credentialing approval and clinic eligibility confirmation.
• Support payer enrollment activities and help resolve payer claim issues.
• Monitor provider and clinic changes and terminations, update databases, and process provider name changes.
• Support payer audits and maintain compliance with MinuteClinic, Joint Commission, and NCQA requirements.
• Monitor and communicate system or state agency interruptions, updates, and password changes to appropriate teams.
• Identify opportunities to improve processes and system efficiencies.
• Collaborate with other coordinators to maintain quality standards, meet productivity benchmarks, and support consistent training and coaching.
• Participate in team meetings and maintain a professional, positive attitude.

Required Qualifications

• Minimum of 3 years of healthcare industry experience, including provider credentialing.
• Demonstrated knowledge of initial credentialing and re-credentialing processes for medical professionals.
• Experience with primary source verification, compliance monitoring, and expirable management.
• Proficiency in quantitative analysis.
• Understanding of Joint Commission accreditation, NCQA, and URAC credentialing standards.
• Proficiency with MDStaff and Microsoft Office, including Excel, Word, and Outlook.
• Strong analytical, critical-thinking, organizational, and multitasking skills.
• Excellent written and verbal communication skills.
• Ability to work independently and collaborate effectively with internal and external stakeholders.
• High school diploma or GED required.
• Associate or bachelor's degree required.

Preferred Qualifications

• NAMSS Certified Professional Credentialing Specialist (CPCS) certification.
• Experience supporting credentialing audits, payer enrollment, and provider compliance activities.

Work Schedule and Environment

• Monday through Friday, 8:00 AM–4:30 PM Eastern Time.
• Hybrid work arrangement, with both onsite and work-from-home flexibility.
• Onsite attendance required as needed.
• Non-patient-facing position.
• Individual start.

Additional Information

• Prior CVS/Aetna work experience is not required.
• Skills-based hiring is not enabled.
• Peak season designation: Not applicable.