Credentialing Coordinator

Summary

American Oncology Network is the hiring organization for this healthcare operations role. The Credentialing Coordinator processes credentialing, re-credentialing, enrollment, and provider updates while maintaining accurate records, supporting compliance, resolving participation issues, and coordinating with providers, payers, hospitals, and internal departments.

Responsibilities

• Coordinate and process initial credentialing, re-credentialing, enrollment, reenrollment, provider updates, and reappointments with commercial payers, government agencies, hospitals, and licensing entities
• Prepare, review, and submit credentialing applications accurately, ensuring completeness and compliance with payer, regulatory, accreditation, and organizational requirements
• Manage provider participation to support timely onboarding and uninterrupted network participation
• Maintain accurate provider records within credentialing systems, CAQH, payer portals, and related databases
• Obtain, verify, and maintain all required credentialing documentation, including licenses, certifications, board certifications, malpractice coverage, DEA registrations, and curriculum vitae
• Monitor licensure, certifications, insurance, and credential expiration dates to ensure continuous compliance and prevent lapses in participation
• Maintain audit-ready files and support accreditation surveys, delegated credentialing activities, and regulatory compliance reviews
• Serve as the primary credentialing contact for assigned providers, payers, hospitals, and internal departments
• Monitor application progress, confirm receipt and submission, and proactively follow up with external organizations to meet established turnaround times
• Collaborate with Provider Relations, Operations, Revenue Cycle, Billing, Compliance, and leadership to support provider onboarding and operational readiness
• Monitor the Credentialing team inbox to ensure timely response to provider, payer, and internal inquiries
• Research, investigate, and resolve credentialing, enrollment, provider participation, and demographic discrepancies to minimize delays
• Escalate credentialing issues, denials, missing documentation, provider non-responsiveness, and other risks impacting participation or reimbursement
• Support departmental initiatives and perform additional credentialing and provider data management responsibilities as assigned
• Maintain complete documentation of credentialing activities and communications within designated tracking systems
• Generate credentialing status reports, aging reports, productivity metrics, and other operational reports
• Prioritize a high-volume workload while meeting quality, productivity, and turnaround standards
• Participate in workflow improvements, departmental projects, and process enhancement initiatives to improve efficiency and service delivery
• Maintain current knowledge of credentialing standards, payer requirements, regulatory updates, and industry best practices
• Support organizational financial objectives by ensuring efficient credentialing operations that minimize reimbursement delays and provider participation interruptions
• Demonstrate fiscal responsibility through effective resource utilization and adherence to departmental budget and purchasing practices

Skills

• High school diploma or GED required
• Valid state driver's license required for travel to satellite offices and off-site meetings
• Strong analytical, critical thinking, problem-solving, decision-making, planning, organizational, and time management skills
• High attention to detail with the ability to exercise sound independent judgment
• Excellent interpersonal skills, emotional intelligence, diplomacy, tact, conflict resolution, and professionalism
• Ability to maintain confidentiality and effectively manage sensitive information
• Strong verbal and written communication skills with the ability to communicate effectively across all levels of the organization
• Customer-focused with the ability to build collaborative relationships with providers, leadership, and cross-functional teams
• Demonstrated ability to prioritize multiple assignments and manage competing deadlines in a fast-paced, multi-site environment
• Self-motivated with the ability to work independently and effectively with limited supervision, including in a remote work environment when required
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook)
• Ability to adapt to changing priorities while maintaining quality, accuracy, and operational efficiency
• Minimum of 2 years of credentialing experience with a strong working knowledge of provider credentialing, enrollment, and recredentialing processes preferred
• Working knowledge of credentialing software, provider databases, and credentialing workflows preferred

Qualifications

Must Haves

• High school diploma or GED required
• Valid state driver's license required for travel to satellite offices and off-site meetings
• Strong analytical, critical thinking, problem-solving, decision-making, planning, organizational, and time management skills
• High attention to detail with the ability to exercise sound independent judgment
• Excellent interpersonal skills, emotional intelligence, diplomacy, tact, conflict resolution, and professionalism
• Ability to maintain confidentiality and effectively manage sensitive information
• Strong verbal and written communication skills with the ability to communicate effectively across all levels of the organization
• Customer-focused with the ability to build collaborative relationships with providers, leadership, and cross-functional teams
• Demonstrated ability to prioritize multiple assignments and manage competing deadlines in a fast-paced, multi-site environment
• Self-motivated with the ability to work independently and effectively with limited supervision, including in a remote work environment when required
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook)
• Ability to adapt to changing priorities while maintaining quality, accuracy, and operational efficiency

Nice to Haves

• Minimum of 2 years of credentialing experience with a strong working knowledge of provider credentialing, enrollment, and recredentialing processes preferred
• Working knowledge of credentialing software, provider databases, and credentialing workflows preferred

Benefits

• Remote Position
• Flexible hours
• Ergonomic home office guidance
• Communication software accessibility