Credentialing Coordinator

What You'll Do:

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