Position Summary
The Credentialing Specialist is responsible for managing and coordinating all aspects of the credentialing and privileging process for new and existing providers. This includes ensuring that providers are properly credentialed with all required facilities and that all necessary documentation is collected, verified, and maintained in accordance with regulatory standards. The Credentialing Specialist plays a critical role in supporting seamless onboarding and ensuring compliance with hospital and accreditation requirements.
Primary Functions & Accountabilities
· Coordinate the full lifecycle of the credentialing and privileging process for new and existing providers, ensuring timely submission of all applications and supporting documents.
· Facilitate comprehensive onboarding for new providers, including the collection of necessary documentation (e.g., licensure, DEA, malpractice insurance, education, training, and certifications).
· Assist providers who are new to the state with applications for medical licenses, DEA registration, and other required credentials.
· Submit and monitor all facility credentialing and recredentialing applications, ensuring compliance with internal deadlines and regulatory standards.
· Maintain accurate and up-to-date provider records in the credentialing and enrollment database, including licensure renewals, expirables tracking, and documentation of communications.
· Conduct thorough primary source verifications of provider credentials and background checks in accordance with NCQA, URAC, and TJC standards.
· Collaborate closely with human resources, medical staff offices, and other departments to support a streamlined provider onboarding experience.
· Ensure that all providers are recredentialed within the required timeframes to avoid lapses in privileges or authorizations.
· Respond to inquiries and requests for credentialing information from internal departments and external stakeholders.
Knowledge, Skills & Abilities
· High school diploma or equivalent required; associate or bachelor’s degree preferred.
· Minimum of 3 years of experience in medical staff services, credentialing, or healthcare administration.
· Strong knowledge of the provider credentialing and privileging process, including standards from NCQA, URAC, TJC, and facility accreditation bodies.
· Experience with primary source verification and provider file audits.
· Familiarity with CAQH and credentialing databases or software systems.
· Understanding of onboarding workflows and the documentation needed for new provider integration is important.
· Exceptional organizational skills, attention to detail, and the ability to manage multiple priorities under tight deadlines.
· Strong communication and interpersonal skills for working with providers, leadership, and external partners.
· Ability to maintain confidentiality and handle sensitive information with professionalism.
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