Medical Credentialing Coordinator

Description:

Work Where There is a Difference-Excellence in Patient Care at Every Level

For over 40 years, Orthopaedic Associates of Wisconsin (OAW) has been the state’s premier orthopedic practice, delivering exceptional care through innovation and expertise. Our team includes highly skilled orthopedic surgeons and dedicated health professionals-all working together at the forefront of surgical advancements, rehabilitation, and patient education. We believe that investing in our staff leads to better patient outcomes.

At OAW, there is a difference.

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Summary of Role

The

Medical Credentialing Coordinator is responsible for ensuring that all healthcare providers, including physicians, advanced practice providers, and allied health professionals, are properly credentialed, licensed, and compliant with regulatory and accreditation standards. This role supports the credentialing process for the ambulatory surgery center (ASC), clinic, MRI, x-ray, and physical therapy departments, ensuring provider eligibility to deliver quality care.

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Key Responsibilities

• Manage the end-to-end credentialing process for all healthcare providers, including initial credentialing, re-credentialing, and ongoing monitoring.
  
• Ensure providers meet the standards set by regulatory bodies, including CMS, The Joint Commission, and state licensing boards.
  
• Maintain a comprehensive credentialing database, tracking licensure, certifications, malpractice coverage, and disciplinary actions.
  
• Review and verify all provider documentation, including education, training, board certifications, licensure, DEA registration, and professional liability insurance.
  
• Conduct primary source verification of all provider qualifications.
  
• Maintain up-to-date files for each provider and ensure compliance with ASC, clinic, MRI, x-ray, and physical therapy credentialing requirements.
  
• Serve as the primary point of contact for providers regarding credentialing status and documentation requirements.
  
• Communicate effectively with providers, insurance companies, regulatory agencies, and other stakeholders regarding credentialing updates.
  
• Collaborate with the Human Resources and Compliance teams to ensure provider onboarding and ongoing compliance.
  
• Improve credentialing efficiency and accuracy while monitoring standards and regulations to advise leadership.
  
• Conduct regular audits of credentialing files to ensure compliance with internal and external standards.
  
• Collaborate with hospital and physical therapy partners while managing and leveraging our third-party credentialing provider as needed.
  

An individual in this position must be able to perform the essential duties and responsibilities listed above successfully. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of this position. The above list reflects the general details necessary to describe the principle and essential functions of the position and shall not be construed as the only duties that may be assigned for the position.

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Your Skills and Experience

Requirements:

• Minimum of 2-7 years of experience in credentialing for an ambulatory surgery center, clinic, or multi-specialty healthcare setting.
  
• Strong understanding of credentialing standards and regulatory requirements (CMS, The Joint Commission, state licensing boards).
  
• Proficiency in credentialing software and Microsoft Office Suite (Word, Excel, Outlook)
  
• Strong verbal and written communication skills
  
• Excellent prioritization, problem-solving skills, decision making, and attention to detail
  
• Ability to work independently
  
• Proactive approach to compliance management
  

Preferred Experience

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification
  
• Experience credentialing for an Orthopedic group
  
• Associate or bachelor�s degree in healthcare administration, Business Administration, or a related field
  

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Your Next Career Move Starts Here!

Apply now and join a highly respected orthopedic practice where your skills make a difference.

Equal Employment Opportunity

OAW provides equal employment opportunity to all applicants and employees. OAW disapproves of, and will not tolerate, unlawful discrimination against any applicant or employee because of race, color, national origin or ancestry, gender (including pregnancy, childbirth, or related medical conditions), gender identity, age, religion, disability, family care status, veteran status, marital status, sexual orientation, or any other basis protected by local, state, or federal laws.