Credentialing Coordinator

4 weeks ago


New York, United States Russell Tobin Full time

Russell Tobin's client, a leading retail company is hiring a Credentialing Coordinator at New York, NY (Hybrid)


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Employment Type: Contract/Hybrid


Location: New York, NY 10018 (Hybrid)


Pay range: $23/hr - $25/hr

Duration: 6+ months (possible extension or conversion)

Job Description:

The Credentialing Coordinator serves as a key resource to administer the credentialing and re-credentialing activities within the team. This role ensures that all providers meet the necessary credentialing requirements for participation.


Major Duties and Responsibilities

Support the overall provider credentialing and re-credentialing processes while maintaining standard turnaround times.

Ensure credentialing and re-credentialing files are initiated promptly and progress according to established standards.

Monitor the participating provider network for credentialing and re-credentialing deficiencies and take necessary action per policies and procedures.

Terminate providers who do not comply with credentialing standards.

Prepare and execute outbound communications related to credentialing events.

Research discrepancies related to provider information.

Assist in preparing weekly rosters for committee approvals or denials of providers.

Support credentialing audits by pulling and preparing files for presentation to external clients.

Obtain missing information from various sources, including providers, to ensure compliance with network standards.

Execute reports to review and update provider information, providing status updates to management.

Prepare reports on the status of credentialing activities.


Top 3-5 Mandatory and/or Minimum Requirements:

Assist with managing the credentialing process and partner with doctors to ensure all paperwork is complete, accurate, and accounted for, including insurance applications and internal paperwork for employed or sublease doctors.

Source information from various internal databases to complete business applications. Identify missing or inaccurate data and research solutions, confirming accuracy while updating all applicable databases with relevant information for credentialing and insurance contracting.

Assist in uncovering and resolving doctor credentialing questions and issues, recommending and creating program enhancements to improve the doctor’s experience.

High School Diploma.

2-3 years of business experience with healthcare provider credentialing.

Proficient in Microsoft Office Products (Word, Excel, Access).

Excellent communication skills (written and verbal).

Ability to work independently, manage time effectively, and handle pressure.

Capacity to manage multiple projects simultaneously.


Preferred Qualifications:

Associate or Bachelor’s Degree.

Knowledge of the credentialing/provider industry.

Demonstrates a sense of urgency.

Experience with operating systems such as EDW/Business Objects.

1-3 years of experience in healthcare with a focus on credentialing operations.

A clear understanding and ongoing knowledge of changes in the Managed Vision Care industry, including credentialing, eligibility checking, claims filing, and payment receipt.

Strong organizational skills and time management.

Benefits that Russell Tobin offers:

Russell Tobin offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.



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