Credentialing Specialist

• Assess and screen initial and reappointment credentialing applications for compliance with regulations and organizational policies
• Conduct primary source document verification
• collect and validate credentials, resolving discrepancies as needed
• Identify and address gaps or errors in information that may impact credentialing, escalating issues to relevant teams for resolution
• Maintain complete and accurate credentialing files, ensuring documentation complies with quality standards and accreditation requirements
• Enter and update provider data in the credentialing database, ensuring accuracy and adapting data as required
• Track and manage credentialing processes, including follow-ups for verification and timely application processing
• Assist in developing and implementing system-wide improvements for credentialing processes
• Generate reports required by regulatory and accrediting bodies to ensure compliance with policies and standards
• Communicate effectively with providers, medical staff leadership, and administrators, addressing credentialing and privileging concerns as they arise
• Perform miscellaneous assigned job-related tasks as needed

• Proficient oral and written communication abilities
• Excellent customer service skills with the ability to address inquiries tactfully and efficiently
• Capable of responding to emails promptly and effectively
• Competence in researching and gathering information
• Strong understanding of medical provider credentialing procedures, principles, policies, and documentation
• Familiarity with clinical or hospital operations and procedures
• Ability to exercise independent judgment in handling confidential information with discretion
• Ability to make sound procedural decisions and judgments
• Advanced knowledge of Microsoft Word and Excel, with the ability to learn and adapt to new applications
• Skilled in prioritizing tasks and independently managing day-to-day responsibilities
• Proficiency in computerized spreadsheet creation and database management

Pursue ongoing professional growth through workshops, seminars, and affiliations to stay updated on healthcare regulations and legislation

• Medical insurance
• Vision insurance
• Dental insurance
• Life insurance
• Disability insurance
• Enrollment in company 401(k) plan
• Free online training
• Competitive compensation