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Job Summary

The Credentialing Specialist is responsible for coordinating and processing all aspects of healthcare provider credentialing to ensure compliance with internal policies, hospital partner requirements, and regulatory standards. This role supports both initial and ongoing credentialing for assigned providers, ensuring timely privilege issuance, regulatory compliance, and accurate data management. The Specialist partners with hospital staff, third-party vendors, and insurance entities to maintain provider readiness and access.

Essential Functions

+ Collects, reviews, and verifies credentialing documentation for completeness and compliance with state, federal, and facility-specific requirements.

+ Processes initial and recredentialing applications, including primary source verifications (PSV), privileging forms, and insurance applications.

+ Tracks licensure, DEA, CSR, and certification renewals to ensure providers maintain active, unexpired credentials.

+ Prepares and submits state collaborative agreements for advanced practice providers and monitors compliance.

+ Coordinates license and credential requests with third-party vendors and monitors through issuance.

+ Serves as liaison between providers, insurance carriers, and hospital credentialing departments to resolve issues and provide status updates.

+ Maintains accurate provider data within credentialing databases, ensuring up-to-date records for internal and external audits.

+ Prepares standard reports related to credentialing activities, expirables, and privileging timelines.

+ Supports insurance enrollment and access setup in accordance with operational standards.

+ Escalates delays or compliance concerns to leadership promptly.

+ Performs other duties as assigned.

+ Maintains regular and reliable attendance.

+ Complies with all policies and standards.

Qualifications

+ H.S. Diploma or GED required

+ Associate Degree in Healthcare Administration, Business, or a related field preferred

+ 2-4 years of experience in credentialing or provider enrollment required

+ Experience supporting hospital credentialing programs or medical staff offices preferred

Knowledge, Skills and Abilities

+ Strong understanding of credentialing processes, regulatory requirements, and accreditation standards (e.g., The Joint Commission, NCQA).

+ Familiarity with provider enrollment and privileging procedures.

+ Excellent attention to detail and accuracy in managing credentialing data.

+ Effective communication and customer service skills.

+ Ability to prioritize tasks, meet deadlines, and manage multiple requests simultaneously.

+ Proficiency in MS Office Suite and credentialing software systems (e.g., MD-Staff or similar).

+ Ability to work independently and handle confidential information with discretion.

Licenses and Certifications

+ Certified Provider Credentialing Specialist (CPCS) preferred

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.