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POSITION SUMMARY

Processes credentialing and re-credentialing applications of health care practitioners/providers. Monitors Credentialing group inbox to ensure all emails are addressed. Researches and solves participation issues as they arise. Supports the financial goals of the company by being fiscally responsible in all areas, including staffing and purchasing.

Key Performance Areas

KPA 1 – Credentialing & Provider Enrollment Management

• 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.

KPA 2 – Provider Data Integrity & Compliance

• 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.

KPA 3 – Credentialing Coordination & Stakeholder Support

• 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.

KPA 4 – Issue Resolution & Operational Support

• 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.

KPA 5 – Reporting, Performance & Process Improvement

• 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.

KPA 6 – Financial Stewardship

• 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.

Position Qualifications

Education

• High school diploma or GED required.

Minimum Relevant Experience

• Minimum of 2 years of credentialing experience with a strong working knowledge of provider credentialing, enrollment, and recredentialing processes preferred.

Certifications/Licenses

• Valid state driver's license required for travel to satellite offices and off-site meetings.

• Must meet requirements of the organization's Driver Safety Operations and Motor Vehicle Records Check Policy.

Skills

• 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).

• Working knowledge of credentialing software, provider databases, and credentialing workflows preferred.

• Ability to adapt to changing priorities while maintaining quality, accuracy, and operational efficiency.

Travel:  0-25%

Expectations for All Employees

This position description reflects the general duties and responsibilities necessary to perform the principal functions of the job, as identified, and shall not be considered an exhaustive list of job responsibilities which may be inherent in the job. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. The responsibilities listed may be subject to change at any time and individuals may be asked to perform duties outside of their regular responsibilities to support the ongoing business operation needs.

Americans with Disabilities Act (ADA) Compliance

The essential functions described herein are intended to define the fundamental duties of the position and serve as the minimum requirements for performance. They do not represent an exhaustive list of all job duties that may be required. AON complies with the Americans with Disabilities Act (ADA) and applicable state and local laws. The Company will engage in an interactive process to evaluate and, where appropriate, provide reasonable accommodations to qualified individuals with disabilities, provided such accommodations do not impose an undue hardship on the business.

Physical Requirements

• Sitting

• Keyboard use

• Minimal lifting

• Long screen exposure

Cognitive Requirements

• Time management

• Effective written/verbal communication

• Policy interpretation

Environmental Requirements

• Home office setup

• Minimal external environmental exposure

Accommodation Notes

• Flexible hours

• Ergonomic home office guidance

• Communication software accessibility

Standard Work Days/Hours (specify weekends and call requirements): Monday to Friday 8:00 AM – 5:00 PM. 

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