Credentialing Specialist

The Credentialing Specialist is accountable for performing the credentialing, re-credentialing and privileging process for the organization. The Credentialing Specialist reports directly to the System Director of Medical Affairs and Provider Enrollment. Responsibilities Processes and maintains provider credentialing and privileging files in accordance with organizational policies, regulatory requirements, and accreditation standards.

Completes routine and assigned credentialing activities in an accurate and timely manner. Processes provider pre-applications and reviews submitted documentation for completeness. Prepares credentialing application packets and distributes them to providers for completion.

Reviews and screens initial appointment and reappointment applications to ensure accuracy, completeness, and compliance with applicable policies, regulations, and guidelines. Identifies, analyzes, and resolves discrepancies, gaps in employment or training history, unusual findings, and other issues that may affect the credentialing process. Communicates credentialing concerns and potential issues to Medical Affairs to support informed decision-making in accordance with Medical Staff Bylaws and credentialing policies.

Participates in the development, implementation, and continuous improvement of system-wide credentialing processes and procedures. Communicates effectively with providers, provider representatives, Medical Affairs personnel, Medical Staff leadership, and administrative staff regarding credentialing and privileging matters. Provides timely responses to requests and inquiries related to credentialing and privileging activities.

Establishes and maintains accurate provider records within credentialing databases and related systems. Maintains current knowledge of healthcare regulations, accreditation standards, and credentialing best practices through continuing education, seminars, workshops, and professional affiliations. Performs primary source verification for all required credentialing elements.

Coordinates with the Medical Staff Office to submit completed credentialing files for review, recommendation, and approval through established Medical Staff processes. Maintains strict confidentiality of provider information and credentialing records. Ensures the accuracy, integrity, and security of credentialing documentation and electronic records.

Performs miscellaneous duties and special projects as assigned. Qualifications

High School Diploma required. Associate Degree preferred. Work

Entry-level position. Two (2) years of relevant credentialing experience preferred. Licensure/Certification: Certified Provider Credentialing Specialist (CPCS) certification preferred, but not required.

Knowledge, Skills, and Abilities: Knowledge and understanding of the provider credentialing process. Ability to organize and prioritize work effectively and manage multiple priorities simultaneously. Excellent verbal and written communication skills, including the ability to prepare professional correspondence, memoranda, and emails.

Strong attention to detail and accuracy. Ability to research, analyze, and interpret data. Ability to work independently with minimal supervision.

Ability to establish and maintain effective working relationships with providers, management, staff, and external contacts. Proficiency in Microsoft Office applications, including Word and Excel. Ability to utilize internet-based resources and credentialing databases effectively.

Day shift