Credentialing Coordinator

At Blue Zones Healthwe are redefining what it means to live a vibrant and healthy lifestyle. Inspired by long-living cultures around the world, we strive to empower people to make simple and sustainable lifestyle changes that lead to longer, better and more fulfilling lives. If you are ready to help transform well-being and be a pivotal part of our team, we want to meet with you!Position SummaryThe Credentialing Coordinator is responsible for overseeing and managing the end-to-end credentialing and enrollment process for new Primary Care Providers (PCPs) at Blue Zones Health(BZH). This position serves as the primary point of contact for credentialing activities, ensuring provider files are complete, submitted timely, and accurately tracked through to health plan ID issuance. The role requires strong organizational skills, attention to detail, and the ability to effectively communicate with providers, internal teams, health plans, and broker partners.Essential Duties & ResponsibilitiesAct as the intake lead for all new PCPs, verifying that contracts and credentialing files are complete before submission.Submit complete provider credentialing files to ACTY (or designee) for processing.Track provider progress to ensure inclusion in scheduled credentialing meetings.After credentialing approval, submit PCP profiles to health plans for enrollment.Monitor and track health plan responses to credentialing submissions, ensuring timely resolution of outstanding items.Coordinate with health plans until all provider IDs are issued and accurately entered into enrollment systems.Collaborate with Regional Broker leads to confirm provider IDs are reflected in the Broker Portal.Provide timely and accurate communication to Regional teams regarding credentialing and enrollment status.Maintain compliance with all regulatory, contractual, and organizational credentialing requirements.Support internal audits and reporting related to credentialing and provider enrollment.Required QualificationsHigh school diploma or equivalent; Associate's or Bachelor's degree in healthcare administration, business, or related field preferred.Minimum of 2 years of experience in provider credentialing, provider enrollment, or healthcare administration.Knowledge of credentialing standards, health plan enrollment requirements, and regulatory compliance.Strong organizational and time-management skills with the ability to manage multiple priorities.Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and credentialing/enrollment systems.Excellent written and verbal communication skills.Ability to maintain confidentiality and handle sensitive information with professionalism.Preferred QualificationsExperience working with ACTY or other MSOsExperience with ACTY or similar credentialing platforms.Previous experience working with health plans, broker networks, or regional provider enrollment processes.Familiarity with NCQA, CMS, CAQH and state credentialing standards.Core CompetenciesAttention to Detail: Ensures accuracy and thoroughness in reviewing and submitting credentialing files.Collaboration: Works effectively with cross-functional teams and external partners to achieve results.Accountability: Takes ownership of tasks and follows through to resolution.Problem-Solving: Identifies issues quickly and works proactively to implement solutions.Communication: Clearly conveys information to providers, health plans, and internal stakeholders.Work Environment & Physical RequirementsStandard office environment: hybrid options may be available.Prolonged periods of sitting at a desk and working on a computer.Occasional lifting of files, records, and documents up to 10 pounds.Travel as neededCompensation & BenefitsBlue Zones Health offers a competitive salary and benefits package, including health, dental, and vision insurance, retirement plan options, paid time off, and opportunities for professional growth and development.The compensation range for this position is $28.00/hr - $33.00/hr depending on experience.For more information about Blue Zones Health, check us out at . Blue Zones Healthdoes not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, veteran status, or any other protected status under applicable law.

Created: 2025-09-24