Credential Verification Provider Navigator

November 13, 2023

Job Description

Job title: Credential Verification Provider Navigator

Company: Presbyterian Health Services

Job description: Overview

Now hiring a full time Provider Navigator for Credential Verification!

Proactively facilitates all aspects of the credentialing, privileging, and provider enrollment processes for newly employed providers. Primary focus is to navigate providers through the credentialing/privileging/enrollment/human resource processes that are required by PMG, PHP and PHS. This includes being the providers one point of contact throughout the onboarding process. The navigator is responsible for managing communication with all impacted departments related to the providers progression through all required steps, to include but not limited to: credentialing with appropriate medical staffs, enrollment with third party payers, and human resource/recruitment activities. Communicates with the provider at regular intervals. Promptly escalates any problems, errors, or other issues that may create delays in the providers commencement of employment;

Type of Opportunity: Full Time

FTE: 1.000000

Exempt: Yes

Work Schedule: Days


  • Two-three years college or Associates Degree with one- three years of experience in medical staff services, physician practices, customer service or other related field. Equivalent relative experience in the industry will be considered in lieu of a degree.
  • One to three years experience in hospital medical staff or managed care credentialing preferred.
  • Excellent written and oral communication skills.
  • Project Management skills.
  • Understanding of the New Mexico medical licensing requirements.
  • Proficient in MS Office Suite, particularly Word and Excel.


Essential: * High School Diploma or GED


*On-boarding coordination for newly hired providers, utilizing and updating internal systems for tracking and reporting progress.

*Review of credentialing applications to determine completeness, and conduct primary source verification of the provider information, following appropriate internal credentialing requirements

*Facilitates the timely and accurate completion of all provider applications within time limits – including but not limited to acquisition of New Mexico Medical License, Controlled Substance Registration (CDS) and Drug Enforcement Agency number (DEA), hospital credentialing, payor enrollment

*Identifies issues during the process and conducts appropriate investigation to resolve these issues

*Obtains the required information for Provider Enrollment and provides it in a timely manner.

*Facilitates the request to establish the providers certificate of insurance (COI)

*Serves as a resource to the providers as well as to other departments (e.g., human resources, recruitment, provider enrollment, administrative leaders, etc.

*Maintains a flexible schedule to allow for evening/weekend capability in order to meet the providers schedule

*Understands and maintains current knowledge of state and federal regulatory requirements and accreditation standards as they apply to all aspects of credentialing

*Utilize the credentialing database for the credentialing process, as well as maintaining relevant data.

*Regularly communicates with the following departments and individuals: Recruitment, Human Resources,Medical Staff Affairs, Provider Enrollment, Director of Practice Operations/Manager of Practice Operations and Medical Directors.Provide updates on the status of providers onboarding process. Determines when issues require escalation to these departments as well as directors of provider operations and medical directors.

*Ensures that all records (electronic and/or paper) are stored in a secure location and that no confidential information is readily available when away from the office/desk

*Maintains a tickler system for follow-up on incomplete applications or unanswered correspondence in order to meet established turnaround times and maintain departmental and the CVO clients standards

*Employs public relations skills in a wide variety of phone contacts and written communications with external sources for purposes of soliciting information essential to credentials verifications, including licensing agencies, university and hospital training program administrators, certification boards, liability insurance carriers, hospital officials and credentials staff, physicians and their office staff.

*Shares responsibility for developing and maintaining an environment that supports service excellence.

*Exercises discretion and independent judgment involving the comparison and the evaluation of possible courses of action related to meeting primary source verification and credentialing requirements. Acts or reaches decisions independently after the various possibilities have been considered.


We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers’ markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian’s story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state’s largest private employer with nearly 14,000 employees – including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture – from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it’s all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Offer Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. Compensation decisions are dependent upon the facts and circumstances of each offer.

Maximum Offer

USD $28.36/Hr.

Expected salary: $18.58 per hour

Location: Albuquerque, NM

Job date: Sun, 05 Nov 2023 00:25:22 GMT

Apply for the job now!