Job Description

Job Summary 

The successful Credentialing Specialist (CS) will be responsible for processing initial and re-credentialing applications of healthcare providers. Reviews applications, processes primary source verifications (PSV), prepares files for review by medical staff leaders and committees. Prepares verification letters and maintains database. May assist with medical staff meetings and committee meeting management. Provides support to the medical staff services department and medical staff. Relies on instructions and pre-established guidelines to perform the functions of the job. 

Essential Functions

Reviews credentialing applications for completeness. Ensures adherence to accreditation standards (e.g., The Joint Commission, NCQA) and regulatory bodies (e.g., CMS, state medical boards). Prepares for and participate in regular internal and external audits regarding credentialing and privileging activities. Stays current with industry regulations and best practices regarding medical staff credentialing and compliance. Maintains and updates the medical staff credentialing database with accurate information for all healthcare providers. Tracks expiration dates for licenses, certifications, and malpractice insurance, ensuring timely renewal. Ensures adherence to accreditation standards (e.g., The Joint Commission, NCQA) and regulatory bodies (e.g., CMS, state medical boards). Prepares for and participate in regular internal and external audits regarding credentialing and privileging activities. Works closely with medical staff leadership, department heads, and administrative teams to ensure the smooth processing of credentialing applications and requests. Communicates effectively with applicants, healthcare organizations, and regulatory bodies to address credentialing issues and concerns. Prepares and maintains reports on credentialing activities, including new applications, reappointments, and expiration tracking. Assists in the preparation of documentation required for medical staff meetings, committee reviews, and regulatory reports. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

Associate Degree in healthcare administration, business administration, or a related field preferred 2-4 years of progressive credentialing experience, preferably within the hospital setting. required

Knowledge, Skills and Abilities

Ability to communicate effectively both orally and in writing. Proficient in MS Office Suite (Excel, Word, Outlook), and Google Suite. Excellent communication and interpersonal skills. Ability to respond to emails timely and effectively. Ability to efficiently take and transcribe accurate meeting minutes and maintain confidentiality. Familiarity with variety of the field’s concepts, practices, and procedures. Ability to use independent judgment and to manage and impart confidential information. Ability to handle confidential information with professionalism and discretion. Skilled in establishing priorities with independent coordination of day-to-day aspects. Proficient in MD-Staff database and all associated features (MD-App, MD-Query, Aiva Cycles, Reports, etc) or strong computer skills with the ability to learn new applications

Licenses and Certifications

(CPCS) Certified Professional Credentialing Specialist preferred