Credentialing Specialist

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McKinney, TX
Overview
Position Type
Full Time 
Education Level
High School
Category
Description

Position Title: Credentialing Specialist

Department: Credentialing

Reports To: Credentialing Team Lead

FLSA: Non-Exempt

Position Summary:

The Credentialing Specialist is responsible for managing hospital facility credentialing, state medical licensing, and provider enrollment processes. This role is essential in ensuring that all providers meet the necessary standards and maintain compliance with federal, state, and facility guidelines.

Essential Duties & Responsibilities:

  • Coordinate the credentialing and re-credentialing process for providers at participating facilities across multiple states.
  • Manage and complete provider enrollment tasks for providers and other staff as needed.
  • Prepare reports and case logs to ensure that providers and staff meet facility, federal, and state guidelines according to Joint Commission standards.
  • Perform Primary Source verification on all providers in compliance with Joint Commission standards and company policies.
  • Maintain and organize credential files for medical and technologist staff, including state medical licenses, Continuing Medical Education (CME), Certificate of Insurance (COI), immunizations, medical education documents, board certifications, CVs/resumes, etc.
  • Utilize credentialing software and electronic platforms for tracking applications and updating hospital affiliations and provider enrollment information.
  • Maintain credentialing calendars to ensure timely renewals of supporting credentials.
  • Apply for and maintain Interpreting Physician state licensure.
Qualifications

Qualifications & Requirements:

Education, Licenses/Certifications:

  • High School diploma or equivalent

Experience:

  • IONM or OON experience is preferred but not required.
  • Qualified or certified for the National Association of Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist (CPCS), or Certified Professional Medical Services Management (CPMSM) is preferred but not required.
  • Experience with Federation of State Medical Boards (FSMB), Federation Credentials Verification Service (FCVS), National Practitioner Data Bank (NPDB), U.S. Department of Health & Human Services Office of Inspector General Exclusion List (HHS OIG), VeriDoc, Interstate Medical Licensure Compact Commission (IMLCC), American Medical Association Physician Profiles (AMA Profiles), Council for Affordable Quality Healthcare ProView (CAQH ProView), Availity and other verification sites.

Skills & Competencies:

  • Strong oral and written communication skills, both over the phone and in person or remotely.
  • Friendly, helpful, and positive team attitude.
  • Responsible, dependable, and organized with a strong work ethic and flexibility.
  • Demonstrate objectivity, professionalism, integrity, and honesty in interactions with people at all levels.
  • Basic office skills, including typing and 10-key abilities.
  • Knowledgeable in multiple Microsoft OSs, VOIP, and the MS Office Suite (Outlook, Excel, Word, PowerPoint, Teams).
  • Capable of working independently with minimal supervision.
  • Self-motivated problem-solver with sound judgment for making independent decisions.

Working Conditions:

  • Generally, work in an office and remote environment.
  • Frequent and prolonged periods of computer and office equipment usage.
  • Ability to manage stress and maintain productivity under tight deadlines and changing priorities.
  • Regular interaction with team members, clients, and other stakeholders through various communication channels.

Physical Demands:

  • Ability to maintain a stationary position for extended periods.
  • Occasionally required to move short to moderate distances.
  • Must be able to lift and/or move up to 50 pounds occasionally.

Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Employees must be able to perform the essential functions of the position satisfactorily. Furthermore, the statements do not establish a contract for employment and are subject to change at the discretion of the Company with or without advance notice.