Credentialing Coordinator

Position Summary

The Credentialing Coordinator at Health Care Partners of South Carolina (HCPSC) will manage the credentialing and re-credentialing process for all health care provider, ensuring compliance with federal, state, and accreditation standards.  This role is essential for maintaining high-quality patient care by guaranteeing that all practitioners possess valid licenses, certifications, and qualifications.  The coordinator will serve as a liaison between providers, internal departments and regulatory organizations, supporting timely onboarding and ongoing provider compliance.

Essential Duties and Responsibilities

• Oversee the credentialing and privileging process for new and existing healthcare providers, including initial credentialing, re-credentialing, and provider enrollment.

• Conduct primary source verification of provider credentials, including education, 

licensure, certifications, training, work history, and malpractice coverage.

• Maintain accurate and up to date provider credentialing files, databases and documentation.

• Track expiration dates of licenses, certifications, and other credentials, facilitating timely renewals and re-credentialing.

• Ensure all credentialing processes comply with federal and state regulations, NCQA, 

HRSA standards.

• Collaborate with internal teams (HR, clinical departments, administration) and external agencies (insurers, credentialing bodies) to coordinate credentialing and onboarding   workflows.

• Respond to provider inquiries regarding credentialing requirements and application status

• Assist in audits and quality assurance reviews, preparing credentialing reports and   metrics for management and regulatory audits.

• Identify discrepancies in provider documentation or qualifications and follow up to  resolve issues.

• Support the development, implementation, and continuous improvement of credentialing policies and procedures.

• In addition to the responsibilities outlined above, you may be asked to perform other duties that are reasonably related to your role and consistent with your skills and experience to support team goals, respond to changing business needs, or address unforeseen challenges

Qualifications

• Minimum of 1-3 years experience in healthcare credentialing or medical administrative roles

• Experience with primary source verification, provider enrollment, and credentialing workflows.

• Familiarity with healthcare regulations (NCQA, Joint Commission, URAC, CMS) and  FQHC practices.

• EHR/EMR systems, and Microsoft Office Suite.

• Strong organizational, attention-to-detail, and time management skills.

• Excellent communication and interpersonal skills, with the ability to interact  professionally with providers, staff, and regulatory agencies.

• Strong adherence to confidentiality, integrity, and problem-solving capabilities

Education Requirements

• Minimum: High School Diploma or GED.

• Preferred:

• Associate’s degree in Healthcare Administration, Medical Office Management,  Business Administration, or related field.

• Bachelor’s degree in Healthcare Management, Public Health, Health Information Management, or Business Administration for larger or leadership roles.

• Certificate programs in Medical Staff Services or Credentialing Specialist preferred.

Health Care Partners of South Carolina is an Equal Opportunity Employer.